Provider Demographics
NPI:1841739513
Name:ENVISION ADHD, S.C.
Entity Type:Organization
Organization Name:ENVISION ADHD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-909-2343
Mailing Address - Street 1:1045 W GLEN OAKS LN STE 205
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3467
Mailing Address - Country:US
Mailing Address - Phone:414-909-2343
Mailing Address - Fax:888-866-4665
Practice Address - Street 1:1045 W GLEN OAKS LN STE 205
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3467
Practice Address - Country:US
Practice Address - Phone:414-909-2343
Practice Address - Fax:888-866-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55027-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty