| Landers Psychotherapy Services Llc | |
|
15460 W Capitol Dr Ste 222 Brookfield WI 53005-2632 | |
| (262) 408-0588 | |
| (262) 599-8119 |
| Full Name | Landers Psychotherapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 15460 W Capitol Dr Ste 222, Brookfield, Wisconsin |
| Authorized Official Name and Position | Jackie Landers (OWNER) |
| Authorized Official Contact | 2624080588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Landers Psychotherapy Services Llc 15460 W Capitol Dr Ste 222 Brookfield WI 53005-2632 Ph: (262) 408-0588 | Landers Psychotherapy Services Llc 15460 W Capitol Dr Ste 222 Brookfield WI 53005-2632 Ph: (262) 408-0588 |
| NPI Number | 1851786529 |
|---|---|
| Provider Enumeration Date | 03/31/2015 |
| Last Update Date | 05/16/2020 |
| Certification Date | 05/16/2020 |
| Medicare PECOS PAC ID | 4082934468 |
|---|---|
| Medicare Enrollment ID | O20150527000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851786529 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 6864123 (Wisconsin) | Secondary |
| 1041C0700X | Social Worker - Clinical | 6864123 (Wisconsin) | Primary |
| Provider Name | Jacqueline L Landers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043303787 PECOS PAC ID: 0840206041 Enrollment ID: I20060224000562 |
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