Provider Demographics
NPI:1043874969
Name:THE ANXIETY CENTER ACQUISITION, LLC
Entity Type:Organization
Organization Name:THE ANXIETY CENTER ACQUISITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITZER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-719-5898
Mailing Address - Street 1:15850 W BLUEMOUND RD STE 208
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15850 W BLUEMOUND RD STE 208
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6007
Practice Address - Country:US
Practice Address - Phone:262-719-5898
Practice Address - Fax:262-641-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1598012890Medicaid