Provider Demographics
NPI:1487830790
Name:COMPREHENSIVE CLINICAL AND CONSULTING SERVICES, INC
Entity Type:Organization
Organization Name:COMPREHENSIVE CLINICAL AND CONSULTING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ITZHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-352-7682
Mailing Address - Street 1:7161 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3877
Mailing Address - Country:US
Mailing Address - Phone:414-352-7682
Mailing Address - Fax:414-352-7625
Practice Address - Street 1:7161 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-3877
Practice Address - Country:US
Practice Address - Phone:414-352-7682
Practice Address - Fax:414-352-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty