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General NPI Number Information
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NPI Number | 1528486263
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Entity Type | Organization
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Legal Business Name | ALAN SUMWALT PSYCHOTHERAPIES LLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 146 PARK AVE PEWAUKEE, WI
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City | PEWAUKEE
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State | WI
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Zip | 53072-3410
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Country | US
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Telephone | 414-588-6452
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Fax | 262-691-3005
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Provider Business Mailing Address
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Address Line | 146 PARK AVE PEWAUKEE, WI
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City | PEWAUKEE
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State | WI
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Zip | 53072-3410
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Country | US
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Telephone | 414-588-6452
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Fax | 262-691-3005
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Authorized Official
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Title or Position | DIRECTOR
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Name | ALAN W SUMWALT
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Credential | MSW, LCSW, LMFT
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Telephone | 414-588-6452
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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 | 346-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 346-123
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License Number State | WI
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