| Psychotherapy Center Of Waunakee Llc | |
|
110 Baker St Ste C Waunakee WI 53597-2707 | |
| (608) 712-9362 | |
| Not Available |
| Full Name | Psychotherapy Center Of Waunakee Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 110 Baker St Ste C, Waunakee, Wisconsin |
| Authorized Official Name and Position | John Raymond Weiss (MEMBER) |
| Authorized Official Contact | 6087129362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychotherapy Center Of Waunakee Llc 928 Lexington Way Waunakee WI 53597-2104 Ph: (608) 712-9362 | Psychotherapy Center Of Waunakee Llc 110 Baker St Ste C Waunakee WI 53597-2707 Ph: (608) 712-9362 |
| NPI Number | 1578196168 |
|---|---|
| Provider Enumeration Date | 02/21/2020 |
| Last Update Date | 02/21/2020 |
| Certification Date | 02/21/2020 |
| Medicare PECOS PAC ID | 4284054347 |
|---|---|
| Medicare Enrollment ID | O20201012002577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578196168 | NPI | - | NPPES |
| 1922512334 | Medicaid | WI | |
| 1316440910 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Melissa P Olsen |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1922512334 PECOS PAC ID: 8628498789 Enrollment ID: I20201014000249 |
| Provider Name | John R Weiss |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1316440910 PECOS PAC ID: 7719307875 Enrollment ID: I20201014000334 |
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