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General NPI Number Information
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NPI Number | 1174331441
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Entity Type | Organization
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Legal Business Name | NEXUS MOMENTUM PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 2135 N 63RD ST
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City | WAUWATOSA
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State | WI
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Zip | 53213-2054
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Country | US
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Telephone | 414-367-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N JEFFERSON ST STE 408 PMB 1250
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City | MILWAUKEE
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State | WI
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Zip | 53202-1924
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Country | US
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Telephone | 414-367-8494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYMBERLEE BLACKFORD
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Credential | LCSW
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Telephone | 414-367-8494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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