Provider Demographics
NPI:1609927011
Name:TUNGSETH PSYCHOTHERAPY CLINIC LLC
Entity Type:Organization
Organization Name:TUNGSETH PSYCHOTHERAPY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUNGSETH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-554-8165
Mailing Address - Street 1:6233 DURAND AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4961
Mailing Address - Country:US
Mailing Address - Phone:262-554-8165
Mailing Address - Fax:262-554-8152
Practice Address - Street 1:6233 DURAND AVE
Practice Address - Street 2:SUITE F
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-554-8165
Practice Address - Fax:262-554-8152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42236800Medicaid