Organization
MILWAUKEE PSYCHOTHERAPY COLLABORATIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID BRIAN SMOTHERS (OWNER)
(414) 367-9413
Entity
Organization
Contact information
Practice address
9120 W HAMPTON AVE STE 212, MILWAUKEE, WI 53225-4960
(414) 367-9413
Mailing address
9120 W HAMPTON AVE STE 212, MILWAUKEE, WI 53225-4960
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2973
WI
103TC1900X
Counseling Psychologist
303957
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100046393
—
WI
05
—
43599400
—
WI
Enumeration date
10/04/2017
Last updated
10/04/2017
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