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NPI Code Detail

MEDICARE: PSYCHOTHERAPY CENTER OF WAUNAKEE LLC

MEDICARE: PSYCHOTHERAPY CENTER OF WAUNAKEE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578196168
Entity Type Code : Organization
Provider Name (Legal Business Name) : PSYCHOTHERAPY CENTER OF WAUNAKEE LLC
Provider Business Mailing Address
First Line : 928 LEXINGTON WAY
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2104
Country : US
Telephone Number : 608-712-9362
Fax Number :
Provider Business Practice Location Address
First Line : 251 PROGRESS WAY STE 102
Second Line :
City : WAUNAKEE
State : WI
Zip : 53597-2520
Country : US
Telephone Number : 608-712-9362
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : JOHN RAYMOND WEISS
Credential : MA, MS, LMFT
Telephone Number : 608-712-9362
Provider Enumeration Date : 02/21/2020
Last Update Date : 03/03/2026

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Directions to “PSYCHOTHERAPY CENTER OF WAUNAKEE LLC ” Practice Location

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