| Premier Medical & Couple Therapy | |
|
1025 W Glen Oaks Ln Ste 208 Mequon WI 53092-3374 | |
| (262) 957-6159 | |
| Not Available |
| Full Name | Premier Medical & Couple Therapy |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1025 W Glen Oaks Ln Ste 208, Mequon, Wisconsin |
| Authorized Official Name and Position | Jeanine Marie Swenson (DIRECTOR & OWNER) |
| Authorized Official Contact | 2629576159 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Medical & Couple Therapy 1025 W Glen Oaks Ln Ste 208 Mequon WI 53092-3374 Ph: (262) 957-6159 | Premier Medical & Couple Therapy 1025 W Glen Oaks Ln Ste 208 Mequon WI 53092-3374 Ph: (262) 957-6159 |
| NPI Number | 1629687108 |
|---|---|
| Provider Enumeration Date | 07/30/2020 |
| Last Update Date | 07/30/2020 |
| Certification Date | 07/30/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629687108 | NPI | - | NPPES |
| G17772 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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