Healthcare Provider Details

I. General information

NPI: 1962867812
Provider Name (Legal Business Name): THREE RIVERS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3364 S 11TH ST
MILWAUKEE WI
53215-5133
US

IV. Provider business mailing address

3364 S 11TH ST
MILWAUKEE WI
53215-5133
US

V. Phone/Fax

Practice location:
  • Phone: 414-285-6456
  • Fax: 414-285-6456
Mailing address:
  • Phone: 414-285-6456
  • Fax: 414-285-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2469-57
License Number StateWI

VIII. Authorized Official

Name: ROBERT A CHUCKA
Title or Position: OWNER
Credential: PSYD
Phone: 414-285-6456