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General NPI Number Information
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NPI Number | 1386847291
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Entity Type | Organization
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Legal Business Name | PSYCARE-MILWAUKEE LLC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 633 W WISCONSIN AVE STE 1810
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City | MILWAUKEE
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State | WI
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Zip | 53203-1908
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Country | US
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Telephone | 414-271-3322
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Fax | 414-271-2335
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Provider Business Mailing Address
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Address Line | 633 W WISCONSIN AVE STE 1810
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City | MILWAUKEE
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State | WI
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Zip | 53203-1908
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Country | US
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Telephone | 414-271-3322
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Fax | 414-271-2335
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS A. GARLAND
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Credential | PSY.D.
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Telephone | 414-271-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1445
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License Number State | WI
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