Provider Demographics
NPI:1003928391
Name:STRESS MANAGEMENT & MENTAL HEALTH CLINICS
Entity Type:Organization
Organization Name:STRESS MANAGEMENT & MENTAL HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:MODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-962-9156
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:# 308
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-329-7000
Mailing Address - Fax:414-329-7010
Practice Address - Street 1:10201 W LINCOLN AVE
Practice Address - Street 2:# 308
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2136
Practice Address - Country:US
Practice Address - Phone:414-329-7000
Practice Address - Fax:414-329-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42163900Medicaid
WI42163900Medicaid
WI000084158Medicare PIN