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Organization

MADISON PSYCHOTHERAPY CENTER, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY ELLEN MILLER MS LPC (CLINIC DIRECTOR)
(608) 233-3037
Entity
Organization

Contact information

Practice address
702 N BLACKHAWK AVE, SUITE 205, MADISON, WI 53705-3357
(608) 233-3037
(608) 233-5893
Mailing address
702 N BLACKHAWK AVE, SUITE 205, MADISON, WI 53901-3357
(608) 233-3037
(608) 233-5893

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1902023435
WI
Enumeration date
03/03/2015
Last updated
03/03/2015
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