Healthcare Provider Details

I. General information

NPI: 1639647597
Provider Name (Legal Business Name): THERAYOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4369 S HOWELL AVE STE 306
MILWAUKEE WI
53207-5098
US

IV. Provider business mailing address

12517 N CENTER DR
MEQUON WI
53092-2602
US

V. Phone/Fax

Practice location:
  • Phone: 414-999-0102
  • Fax: 262-236-7701
Mailing address:
  • Phone: 414-795-7112
  • Fax: 262-236-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA FRANZOLIN
Title or Position: PSYCHOTHERAPIST
Credential: LPC
Phone: 414-795-7112