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General NPI Number Information
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NPI Number | 1578515417
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIORAL MEDICINE, SC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 13400 BISHOPS LN STE 290
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City | BROOKFIELD
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State | WI
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Zip | 53005-6254
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Country | US
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Telephone | 262-782-2820
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Fax | 262-782-6937
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Provider Business Mailing Address
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Address Line | 13400 BISHOPS LN STE 290
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City | BROOKFIELD
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State | WI
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Zip | 53005-6254
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Country | US
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Telephone | 262-782-2820
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Fax | 262-782-6937
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Authorized Official
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Title or Position | PRESIDENT
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Name | NEAL MOGLOWSKY
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Credential | LPC
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Telephone | 262-782-2820
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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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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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