| Milwaukee Psychotherapy Collaborative | |
|
9120 W Hampton Ave Ste 212 Milwaukee WI 53225-4960 | |
| (414) 367-9413 | |
| Not Available |
| Full Name | Milwaukee Psychotherapy Collaborative |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 9120 W Hampton Ave Ste 212, Milwaukee, Wisconsin |
| Authorized Official Name and Position | David Brian Smothers (OWNER) |
| Authorized Official Contact | 4143679413 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Milwaukee Psychotherapy Collaborative 9120 W Hampton Ave Ste 212 Milwaukee WI 53225-4960 Ph: () - | Milwaukee Psychotherapy Collaborative 9120 W Hampton Ave Ste 212 Milwaukee WI 53225-4960 Ph: (414) 367-9413 |
| NPI Number | 1760992788 |
|---|---|
| Provider Enumeration Date | 10/04/2017 |
| Last Update Date | 10/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760992788 | NPI | - | NPPES |
| 100046393 | Medicaid | WI | |
| 43599400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2973 (Wisconsin) | Primary |
| 103TC1900X | Psychologist - Counseling | 303957 (Wisconsin) | Secondary |
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