MEDICARE: THERAPEUTIC WORKSHOP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497430359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC WORKSHOP, LLC

Provider Business Mailing Address
First Line	:	2625 S GREELEY ST
Second Line	:	BOX #9
City	:	MILWAUKEE
State	:	WI
Zip	:	53207
Country	:	US
Telephone Number	:	414-644-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 S GREELEY ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-2024
Country	:	US
Telephone Number	:	414-779-0107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GREG SCHOENECK
Credential	:	LPC
Telephone Number	:	414-644-0006

Provider Enumeration Date	:	06/19/2023
Last Update Date	:	06/27/2023

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