Healthcare Provider Details

I. General information

NPI: 1306619234
Provider Name (Legal Business Name): OCD AND ANXIETY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16535 W BLUEMOUND RD STE 321
BROOKFIELD WI
53005-5936
US

IV. Provider business mailing address

16535 W BLUEMOUND RD STE 321
BROOKFIELD WI
53005-5936
US

V. Phone/Fax

Practice location:
  • Phone: 262-202-8512
  • Fax:
Mailing address:
  • Phone: 262-202-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAMON BUCKETT
Title or Position: OWNER, OPERATOR
Credential: LCSW
Phone: 262-202-8512