Organization
MADISON PSYCHOTHERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ELLEN MILLER LPC (PSYCHOTHERAPIST)
(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 53705-3357
(608) 233-3037
(608) 233-5893
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42177200
—
WI
Enumeration date
04/19/2007
Last updated
03/05/2015
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