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General NPI Number Information
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NPI Number | 1932493798
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE SPECIALISTS, LLC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 801 S 70TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-3147
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Country | US
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Telephone | 414-429-8352
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Fax |
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Provider Business Mailing Address
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Address Line | 4041 N PROSPECT AVE
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City | SHOREWOOD
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State | WI
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Zip | 53211-2121
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Country | US
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Telephone | 414-429-8352
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD KARTHEISER
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Credential | M.A., LPC
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Telephone | 414-429-8352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1212-125
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License Number State | WI
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