Provider Demographics
NPI:1922249929
Name:STRESS MANAGEMENT & MENTAL HEALTH CLINICS
Entity Type:Organization
Organization Name:STRESS MANAGEMENT & MENTAL HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CO-OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MODELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-962-9156
Mailing Address - Street 1:10201 W LINCOLN AVE
Mailing Address - Street 2:#308
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2136
Mailing Address - Country:US
Mailing Address - Phone:414-329-7000
Mailing Address - Fax:414-329-7010
Practice Address - Street 1:5225 N IRONWOOD RD
Practice Address - Street 2:#102
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4909
Practice Address - Country:US
Practice Address - Phone:414-962-9156
Practice Address - Fax:414-962-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7439-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty