Provider Demographics
NPI:1922701812
Name:WATER TIGER PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:WATER TIGER PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-215-1254
Mailing Address - Street 1:100 WILBURN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1478
Mailing Address - Country:US
Mailing Address - Phone:920-215-1254
Mailing Address - Fax:
Practice Address - Street 1:2002 ATWOOD AVE STE 217
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5382
Practice Address - Country:US
Practice Address - Phone:920-215-1254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health