Organization
TOMBOLO, LLC
Active
Other names
Connections
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENEE L. GENIN LCSW (PSYCHOTHERAPIST/CHILD SPECIALIST)
(414) 708-5988
Entity
Organization
Contact information
Practice address
12545 W. BURLEIGH RD., SUITE 10, BROOKFIELD, WI 53005
(414) 708-5988
Mailing address
12545 W BURLEIGH RD STE 10, BROOKFIELD, WI 53005-3101
(414) 708-5988
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
7050-123
WI
261QM0850X
Adult Mental Health Clinic/Center
7050-123
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
7050-123
WI
Other
Enumeration date
08/01/2017
Last updated
07/21/2022
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