| Birt Supportive Services Llc | |
|
6815 W Capitol Dr Ste 105 Milwaukee WI 53216-2056 | |
| (414) 522-6800 | |
| (414) 240-8497 |
| Full Name | Birt Supportive Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6815 W Capitol Dr Ste 105, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Reginald Birt (PSYCHOTHERAPIST) |
| Authorized Official Contact | 4145226800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Birt Supportive Services Llc 4868 N 89th St Milwaukee WI 53225-4106 Ph: (414) 522-6800 | Birt Supportive Services Llc 6815 W Capitol Dr Ste 105 Milwaukee WI 53216-2056 Ph: (414) 522-6800 |
| NPI Number | 1689149700 |
|---|---|
| Provider Enumeration Date | 10/04/2018 |
| Last Update Date | 04/26/2022 |
| Certification Date | 04/26/2022 |
| Medicare PECOS PAC ID | 6507243904 |
|---|---|
| Medicare Enrollment ID | O20220524000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689149700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Reginald T Birt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487999207 PECOS PAC ID: 9739463415 Enrollment ID: I20170223002263 |
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