Provider Demographics
NPI:1376181677
Name:AMY BREHM-UNOLD, LMFT, LLC
Entity Type:Organization
Organization Name:AMY BREHM-UNOLD, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BREHM-UNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:920-570-0050
Mailing Address - Street 1:S25W26195 MAC ARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5503
Mailing Address - Country:US
Mailing Address - Phone:920-570-0050
Mailing Address - Fax:
Practice Address - Street 1:2717 N GRANDVIEW BLVD STE 204
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1660
Practice Address - Country:US
Practice Address - Phone:920-570-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health