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General NPI Number Information
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NPI Number | 1831315191
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Entity Type | Organization
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Legal Business Name | ALLIED MENTAL HEALTH SPECIALTY GROUP SC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 05/09/2020
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Provider Practice Location Address
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Address Line | 1334 HOSFORD ST STE B
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City | HUDSON
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State | WI
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Zip | 54016-9230
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Country | US
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Telephone | 715-808-0795
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Fax | 715-808-0361
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Provider Business Mailing Address
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Address Line | 1334 HOSFORD ST STE B
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City | HUDSON
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State | WI
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Zip | 54016-9230
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Country | US
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Telephone | 715-808-0795
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Fax | 715-808-0361
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY G NEVINS
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Credential |
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Telephone | 715-808-0795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1436-057
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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