| Ebb Tide Therapy | |
|
2821 N 4th St Ste 209 Milwaukee WI 53212-2367 | |
| (414) 372-7212 | |
| (414) 372-7213 |
| Full Name | Ebb Tide Therapy |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2821 N 4th St Ste 209, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Shannon Gae O'brien (THERAPIST) |
| Authorized Official Contact | 4143727212 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebb Tide Therapy 2821 N 4th St Ste 209 Milwaukee WI 53212-2367 Ph: (414) 372-7212 | Ebb Tide Therapy 2821 N 4th St Ste 209 Milwaukee WI 53212-2367 Ph: (414) 372-7212 |
| NPI Number | 1720353741 |
|---|---|
| Provider Enumeration Date | 03/09/2012 |
| Last Update Date | 07/05/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720353741 | NPI | - | NPPES |
| 1366529182 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1971-132 (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 7197-123 (Wisconsin) | Primary |
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