Provider Demographics
NPI:1235666017
Name:MYLES TONNACLIFF PH.D, LLC
Entity Type:Organization
Organization Name:MYLES TONNACLIFF PH.D, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICESED PSYCHOLOGIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:TONNACLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:262-618-2856
Mailing Address - Street 1:W62N248 WASHINGTON AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2768
Mailing Address - Country:US
Mailing Address - Phone:414-617-2663
Mailing Address - Fax:
Practice Address - Street 1:W62N248 WASHINGTON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2768
Practice Address - Country:US
Practice Address - Phone:262-618-2856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2163-57261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)