| Shore Counseling And Consulting Clinic, S.c. | |
|
2600 N Mayfair Rd Suite 650 Milwaukee WI 53226-1309 | |
| (414) 771-9304 | |
| (414) 771-9543 |
| Full Name | Shore Counseling And Consulting Clinic, S.c. |
|---|---|
| Speciality | Psychologist |
| Location | 2600 N Mayfair Rd, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Thomas Troast (CLINICAL DIRECTOR) |
| Authorized Official Contact | 4147719304 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shore Counseling And Consulting Clinic, S.c. 2600 N Mayfair Rd Suite 650 Milwaukee WI 53226-1309 Ph: (414) 771-9304 | Shore Counseling And Consulting Clinic, S.c. 2600 N Mayfair Rd Suite 650 Milwaukee WI 53226-1309 Ph: (414) 771-9304 |
| NPI Number | 1588710073 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 08/04/2015 |
| Medicare PECOS PAC ID | 3072580547 |
|---|---|
| Medicare Enrollment ID | O20040914000637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588710073 | NPI | - | NPPES |
| 42247200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Primary |
| Provider Name | Pamela Prestby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1790805885 PECOS PAC ID: 6507753373 Enrollment ID: I20040304000568 |
| Provider Name | Terri S Fitzgibbon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346325495 PECOS PAC ID: 1052302171 Enrollment ID: I20040519000234 |
| Provider Name | Virginia L Dotson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164573804 PECOS PAC ID: 6204803711 Enrollment ID: I20040914000875 |
| Provider Name | Marla Jo Larock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508881863 PECOS PAC ID: 0042223380 Enrollment ID: I20060803000170 |
| Provider Name | John E Prestby |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184770752 PECOS PAC ID: 6901906924 Enrollment ID: I20070705000198 |
| Provider Name | Diane M Odonnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952482705 PECOS PAC ID: 8426056516 Enrollment ID: I20100823001083 |
| Provider Name | Dana Vaughan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972668051 PECOS PAC ID: 9931324373 Enrollment ID: I20140627000813 |
| Provider Name | Jodee J Kuhl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366884264 PECOS PAC ID: 2365734225 Enrollment ID: I20160713001438 |
| Provider Name | John E Troast |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962939504 PECOS PAC ID: 5193117190 Enrollment ID: I20220125002794 |
| Provider Name | Kathryn A Schaetzke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730411596 PECOS PAC ID: 0042668956 Enrollment ID: I20240108000172 |
| Provider Name | Lindsay N Price |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1275182511 PECOS PAC ID: 9931550266 Enrollment ID: I20240110004332 |
| Provider Name | Ellen M Reid |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588014674 PECOS PAC ID: 4789036070 Enrollment ID: I20240123001743 |
| Provider Name | Jordan M Chevako |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154898252 PECOS PAC ID: 1052764107 Enrollment ID: I20240125001480 |
| Provider Name | Thomas P Troast |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245386739 PECOS PAC ID: 2860469335 Enrollment ID: I20240213003081 |
| Provider Name | Laura E Gray |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760508113 PECOS PAC ID: 2466896477 Enrollment ID: I20240219000425 |
| Provider Name | Paula J Hillmann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669778619 PECOS PAC ID: 1850736174 Enrollment ID: I20240227000871 |
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