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General NPI Number Information
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NPI Number | 1881935401
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Entity Type | Organization
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Legal Business Name | THEIS AND ASSOCIATES, LLC
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Dates
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Enumeration Date | 03/06/2013
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 4818 S 76TH ST
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City | GREENFIELD
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State | WI
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Zip | 53220-4362
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Country | US
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Telephone | 414-418-4109
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Fax | 414-421-7871
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Provider Business Mailing Address
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Address Line | 4343 SKYLARK CT
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City | GREENDALE
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State | WI
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Zip | 53129-2902
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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 | PRESIDENT
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Name | MR. GERALD THEIS
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Credential | LCSW
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Telephone | 414-418-1409
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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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