Provider Demographics
NPI:1598276719
Name:CORE CENTER FOR COUPLES AND THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CORE CENTER FOR COUPLES AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:414-214-7326
Mailing Address - Street 1:10855 W POTTER RD STE 23
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3439
Mailing Address - Country:US
Mailing Address - Phone:414-214-7326
Mailing Address - Fax:
Practice Address - Street 1:10855 W POTTER RD STE 23
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3439
Practice Address - Country:US
Practice Address - Phone:414-214-7326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-15
Last Update Date:2017-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI920-124261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871873075Medicaid