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General NPI Number Information
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NPI Number | 1386048551
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Entity Type | Organization
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Legal Business Name | TARVID COUNSELING LLC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 740 PILGRIM PKWY SUITE 103
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City | ELM GROVE
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State | WI
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Zip | 53122-2066
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Country | US
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Telephone | 414-491-0377
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Fax |
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Provider Business Mailing Address
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Address Line | 7670 W HONEY CREEK PKWY
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City | WEST ALLIS
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State | WI
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Zip | 53219-2738
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Country | US
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Telephone | 414-491-0377
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT/MBR
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Name | MS. SALLY S TARVID
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Credential | LCSW
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Telephone | 414-491-0377
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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 | 7099-123
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License Number State | WI
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