Provider Demographics
NPI:1619918877
Name:MCPST MANAGEMENT CORPORATION
Entity Type:Organization
Organization Name:MCPST MANAGEMENT CORPORATION
Other - Org Name:MIDWEST CTR FOR PSYCHOTHERAPY & SEX THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILGOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-237-8000
Mailing Address - Street 1:6300 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3463
Mailing Address - Country:US
Mailing Address - Phone:608-237-8000
Mailing Address - Fax:608-237-8005
Practice Address - Street 1:6300 UNIVERSITY AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3463
Practice Address - Country:US
Practice Address - Phone:608-237-8000
Practice Address - Fax:608-237-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42172000Medicaid
WI42172000Medicaid
WI000088372Medicare ID - Type Unspecified