| M D Therapy Llc | |
|
3118 N Teutonia Ave Milwaukee WI 53206-2264 | |
| (414) 264-6155 | |
| (414) 264-8288 |
| Full Name | M D Therapy Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3118 N Teutonia Ave, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Thomas Michael Dale (PRESIDENT) |
| Authorized Official Contact | 4142646155 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| M D Therapy Llc 3118 N Teutonia Ave Milwaukee WI 53206-2264 Ph: (414) 264-6155 | M D Therapy Llc 3118 N Teutonia Ave Milwaukee WI 53206-2264 Ph: (414) 264-6155 |
| NPI Number | 1811193675 |
|---|---|
| Provider Enumeration Date | 06/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811193675 | NPI | - | NPPES |
| HFS 61.91 | Other | WI | MENTAL HEALTH-OUTPATIENT |
| HFS 75.13 | Other | WI | CSAS-OUTPATIENT TREATMENT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 2225 (Wisconsin) | Primary |
| 106H00000X | Marriage & Family Therapist | 2225 (Wisconsin) | Primary |
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