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General NPI Number Information
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NPI Number | 1689149700
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Entity Type | Organization
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Legal Business Name | BIRT SUPPORTIVE SERVICES LLC
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 6815 W CAPITOL DR STE 105
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City | MILWAUKEE
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State | WI
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Zip | 53216-2056
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Country | US
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Telephone | 414-522-6800
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Fax | 414-240-8497
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Provider Business Mailing Address
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Address Line | 4868 N 89TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-4106
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Country | US
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Telephone | 414-522-6800
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Fax | 414-240-8497
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. REGINALD BIRT
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Credential | LCSW, MBA
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Telephone | 414-522-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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