Provider Demographics
NPI:1558586016
Name:CLEAR DIRECTION PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:CLEAR DIRECTION PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:URTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-332-3390
Mailing Address - Street 1:6110 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4308
Mailing Address - Country:US
Mailing Address - Phone:414-332-3390
Mailing Address - Fax:414-332-3392
Practice Address - Street 1:6110 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4308
Practice Address - Country:US
Practice Address - Phone:414-332-3390
Practice Address - Fax:414-332-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI166708OtherMANAGED HEALTH NETWORK
WIV543NOtherBLUE CROSS BLUE SHIELD
WI157211OtherVALUEOPTIONS PROVIDER
WI39020900Medicaid
WI4017291OtherAETNA PROVIDER NUMBER
WIV543NOtherBLUE CROSS BLUE SHIELD
WI157211OtherVALUEOPTIONS PROVIDER
WIV543NOtherBLUE CROSS BLUE SHIELD