Healthcare Provider Details

I. General information

NPI: 1356267314
Provider Name (Legal Business Name): CENTER FOR SELF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SHERMAN AVE
SOUTH MILWAUKEE WI
53172-3803
US

IV. Provider business mailing address

705 SHERMAN AVE
SOUTH MILWAUKEE WI
53172-3803
US

V. Phone/Fax

Practice location:
  • Phone: 414-375-5214
  • Fax:
Mailing address:
  • Phone: 414-375-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: TORY SKYE ELLIOTT
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 414-375-5214