MEDICARE: THERAYOLOGY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	101YP2500X	Professional Counselor
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1639647597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAYOLOGY, LLC

Provider Business Mailing Address
First Line	:	12517 N CENTER DR
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-2602
Country	:	US
Telephone Number	:	414-795-7112
Fax Number	:	262-236-7701

Provider Business Practice Location Address
First Line	:	4369 S HOWELL AVE STE 306
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-5098
Country	:	US
Telephone Number	:	414-999-0102
Fax Number	:	262-236-7701

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	CYNTHIA FRANZOLIN
Credential	:	LPC
Telephone Number	:	414-795-7112

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	05/28/2026

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Directions to “THERAYOLOGY, LLC ” Practice Location

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