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General NPI Number Information
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NPI Number | 1164256038
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Entity Type | Organization
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Legal Business Name | TOSA PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 08/31/2024
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 10425 W NORTH AVE STE 350
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City | WAUWATOSA
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State | WI
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Zip | 53226-2416
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Country | US
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Telephone | 414-522-7899
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Fax |
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Provider Business Mailing Address
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Address Line | 2796 N 98TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-4551
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOMENICK TIRABASSI IV
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Credential | PSYD
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Telephone | 262-818-9888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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