Provider Demographics
NPI:1295139012
Name:TAMMY GIANNOPOULOS, LLC
Entity type:Organization
Organization Name:TAMMY GIANNOPOULOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-331-8167
Mailing Address - Street 1:4402 S 68TH ST SUITE 100
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220
Mailing Address - Country:US
Mailing Address - Phone:414-331-8167
Mailing Address - Fax:414-321-0552
Practice Address - Street 1:4402 S 68TH ST SUITE 100
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220
Practice Address - Country:US
Practice Address - Phone:414-331-8167
Practice Address - Fax:414-321-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7779-123261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100016425Medicaid