Healthcare Provider Details

I. General information

NPI: 1609780154
Provider Name (Legal Business Name): MJR INTEGRATIVE PSYCHIATRY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 N 48TH ST
MILWAUKEE WI
53208-1124
US

IV. Provider business mailing address

2203 N 48TH ST
MILWAUKEE WI
53208-1124
US

V. Phone/Fax

Practice location:
  • Phone: 414-522-7786
  • Fax:
Mailing address:
  • Phone: 414-530-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL J RODRIQUES
Title or Position: OWNER
Credential: MSN, APRN, PMHNP-BC
Phone: 414-530-8896