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General NPI Number Information
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NPI Number | 1295556975
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Entity Type | Organization
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Legal Business Name | THIRD WAVE PSYCHOTHERAPY & ASSESSMENT, LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 2180 S 87TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-1720
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Country | US
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Telephone | 414-215-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 S 87TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-1720
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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 | PSYCHOLOGIST/OWNER
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Name | DR. KRISTEN PAYNE
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Credential | PHD
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Telephone | 414-215-0017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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