1922249929 NPI number — STRESS MANAGEMENT & MENTAL HEALTH CLINICS

Table of content: (NPI 1922249929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922249929 NPI number — STRESS MANAGEMENT & MENTAL HEALTH CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRESS MANAGEMENT & MENTAL HEALTH CLINICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922249929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10201 W LINCOLN AVE
Provider Second Line Business Mailing Address:
#308
Provider Business Mailing Address City Name:
WEST ALLIS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53227-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-329-7000
Provider Business Mailing Address Fax Number:
414-329-7010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5225 N IRONWOOD RD
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53217-4909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-962-9156
Provider Business Practice Location Address Fax Number:
414-962-4356
Provider Enumeration Date:
03/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MODELL
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DIRECTOR/CO-OWNER
Authorized Official Telephone Number:
414-962-9156

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  7439-123 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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