Organization
M D THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS MICHAEL DALE ED PSYCHOLOGY (PSYCHOTERAPIST)
(414) 466-3204
Entity
Organization
Contact information
Practice address
6815 W CAPITOL DR, SUITE 208, MILWAUKEE, WI 53216-2070
(414) 466-3204
(414) 466-3206
Mailing address
6815 W CAPITOL DR, SUITE 208, MILWAUKEE, WI 53216-2070
(414) 466-3204
(414) 466-3206
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
HFS 61.91
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42217600
—
WI
Enumeration date
10/01/2007
Last updated
08/26/2008
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