Basic Information
| Provider Information | |||||||||
| NPI: | 1578029443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEE HAPPY THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | N7269 COLBO RD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531052525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627498687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 647 W MAIN ST STE 900 | ||||||||
| Address2: | |||||||||
| City: | LAKE GENEVA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531471985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627498687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2019 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | COLLINS | ||||||||
| AuthorizedOfficialFirstName: | KATEY | ||||||||
| AuthorizedOfficialMiddleName: | DIANE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2627498687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 1041C0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1134613656 | 01 | WI | NPI FOR PROVIDER - KATHERINE COLLINS | OTHER | 8942-123 | 01 | WI | STATE LICENESE FOR KATHERINE COLLINS - LCSW | OTHER |