| Madison Psychotherapy Center, Llc | |
|
702 N Blackhawk Ave Suite 205 Madison WI 53705-3357 | |
| (608) 233-3037 | |
| (608) 233-5893 |
| Full Name | Madison Psychotherapy Center, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 702 N Blackhawk Ave, Madison, Wisconsin |
| Authorized Official Name and Position | Mary Ellen Miller (CLINIC DIRECTOR) |
| Authorized Official Contact | 6082333037 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Madison Psychotherapy Center, Llc 702 N Blackhawk Ave Suite 205 Madison WI 53901-3357 Ph: (608) 233-3037 | Madison Psychotherapy Center, Llc 702 N Blackhawk Ave Suite 205 Madison WI 53705-3357 Ph: (608) 233-3037 |
| NPI Number | 1063804870 |
|---|---|
| Provider Enumeration Date | 03/03/2015 |
| Last Update Date | 03/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063804870 | NPI | - | NPPES |
| 1902023435 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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