Provider Demographics
NPI:1477199602
Name:AIMEE METZGER PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:AIMEE METZGER PSYCHOTHERAPY LLC
Other - Org Name:AIMEE METZGER PSYCHOTHERAPY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-804-7729
Mailing Address - Street 1:405 E FOREST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3707
Mailing Address - Country:US
Mailing Address - Phone:262-804-7729
Mailing Address - Fax:
Practice Address - Street 1:405 E FOREST ST STE 106
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3707
Practice Address - Country:US
Practice Address - Phone:262-490-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10080061Medicaid