Provider Demographics
NPI:1659387009
Name:WKM PSYCHOLOGY CLINICS, INC.
Entity Type:Organization
Organization Name:WKM PSYCHOLOGY CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:608-342-4853
Mailing Address - Street 1:6058 S CHESTNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-8947
Mailing Address - Country:US
Mailing Address - Phone:608-342-4853
Mailing Address - Fax:608-342-4810
Practice Address - Street 1:6058 S CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-8947
Practice Address - Country:US
Practice Address - Phone:608-342-4853
Practice Address - Fax:608-342-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42146000Medicaid
WI42146000Medicaid