Healthcare Provider Details

I. General information

NPI: 1124124532
Provider Name (Legal Business Name): THOMAS F BYRNES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE SUITE 608
MILWAUKEE WI
53202
US

IV. Provider business mailing address

2266 N PROSPECT AVE SUITE 608
MILWAUKEE WI
53202
US

V. Phone/Fax

Practice location:
  • Phone: 414-224-0492
  • Fax: 414-224-8112
Mailing address:
  • Phone: 414-224-0492
  • Fax: 414-224-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number986125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: