Healthcare Provider Details

I. General information

NPI: 1588710073
Provider Name (Legal Business Name): SHORE COUNSELING AND CONSULTING CLINIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N MAYFAIR RD SUITE 650
MILWAUKEE WI
53226-1309
US

IV. Provider business mailing address

2600 N MAYFAIR RD SUITE 650
MILWAUKEE WI
53226-1309
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-9304
  • Fax: 414-771-9543
Mailing address:
  • Phone: 414-771-9304
  • Fax: 414-771-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS TROAST
Title or Position: CLINICAL DIRECTOR
Credential: PHD
Phone: 414-771-9304