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General NPI Number Information
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NPI Number | 1538590393
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL PURPOSES LLC
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Dates
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Enumeration Date | 12/04/2013
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Last Update Date | 12/04/2013
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Provider Practice Location Address
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Address Line | 3229 S ADAMS AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-2705
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Country | US
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Telephone | 773-398-4648
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Fax |
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Provider Business Mailing Address
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Address Line | 3229 S ADAMS AVE
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City | MILWAUKEE
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State | WI
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Zip | 53207-2705
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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
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Name | BENJAMIN RADER
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Credential |
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Telephone | 262-780-1405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 294557
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License Number State | WI
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