Healthcare Provider Details

I. General information

NPI: 1770160947
Provider Name (Legal Business Name): POD HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14135 N CEDARBURG RD
MEQUON WI
53097-1416
US

IV. Provider business mailing address

14135 N CEDARBURG RD
MEQUON WI
53097-1416
US

V. Phone/Fax

Practice location:
  • Phone: 262-377-2006
  • Fax:
Mailing address:
  • Phone: 262-377-2006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DREW DYRSSEN
Title or Position: OWNER
Credential: LPC, NCC, BC-TMH
Phone: 760-917-4494