| In Depth Psychotherapy, Llc | |
|
10425 W North Ave Ste 239 Wauwatosa WI 53226-2416 | |
| (715) 281-9259 | |
| Not Available |
| Full Name | In Depth Psychotherapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10425 W North Ave Ste 239, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Carli Gurholt (PSYCHOLOGIST) |
| Authorized Official Contact | 7152819259 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| In Depth Psychotherapy, Llc 10425 W North Ave Ste 239 Wauwatosa WI 53226-2416 Ph: () - | In Depth Psychotherapy, Llc 10425 W North Ave Ste 239 Wauwatosa WI 53226-2416 Ph: (715) 281-9259 |
| NPI Number | 1730879503 |
|---|---|
| Provider Enumeration Date | 05/15/2023 |
| Last Update Date | 05/15/2023 |
| Certification Date | 05/13/2023 |
| Medicare PECOS PAC ID | 8022456227 |
|---|---|
| Medicare Enrollment ID | O20240408001350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730879503 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Carli R Gurholt |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1255059333 PECOS PAC ID: 4688037302 Enrollment ID: I20230829001961 |
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