| 212 Psychotherapy Llc | |
|
437 S Yellowstone Dr Madison WI 53719-2902 | |
| (608) 516-4347 | |
| Not Available |
| Full Name | 212 Psychotherapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 437 S Yellowstone Dr, Madison, Wisconsin |
| Authorized Official Name and Position | Tanya Kc Hiser (OWNER) |
| Authorized Official Contact | 6085164347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 212 Psychotherapy Llc 7109 Brindley Cir Madison WI 53719-2128 Ph: (608) 516-4347 | 212 Psychotherapy Llc 437 S Yellowstone Dr Madison WI 53719-2902 Ph: (608) 516-4347 |
| NPI Number | 1053941666 |
|---|---|
| Provider Enumeration Date | 01/22/2020 |
| Last Update Date | 04/02/2021 |
| Certification Date | 04/02/2021 |
| Medicare PECOS PAC ID | 9234547829 |
|---|---|
| Medicare Enrollment ID | O20210420002439 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053941666 | NPI | - | NPPES |
| 43741200 | Medicaid | WI | |
| 100098189 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Faith J Lerner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891756771 PECOS PAC ID: 6800952821 Enrollment ID: I20090226000656 |
| Provider Name | Sarah L Splinter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770729592 PECOS PAC ID: 3072786490 Enrollment ID: I20111101000119 |
| Provider Name | Sara Kelly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922318377 PECOS PAC ID: 9032455381 Enrollment ID: I20190108002595 |
| Provider Name | Nichole Ashley Sloniker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982349106 PECOS PAC ID: 9739566340 Enrollment ID: I20220520001800 |
| Provider Name | Amysue Sue Hartman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568747475 PECOS PAC ID: 0648614651 Enrollment ID: I20240219000421 |
| Provider Name | Heather J Liebe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821518259 PECOS PAC ID: 9739523762 Enrollment ID: I20240219001158 |
| Provider Name | Carmen D Sperle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487311452 PECOS PAC ID: 3971948928 Enrollment ID: I20240229000640 |
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