Provider Demographics
NPI:1881966588
Name:BEHRENS PSYCHOTHERAPY SERVICES, LLC
Entity type:Organization
Organization Name:BEHRENS PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEHRENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:262-689-0688
Mailing Address - Street 1:10501 N MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5532
Mailing Address - Country:US
Mailing Address - Phone:262-689-0688
Mailing Address - Fax:262-242-3219
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1956
Practice Address - Country:US
Practice Address - Phone:262-689-0688
Practice Address - Fax:262-242-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4073-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1518173772OtherINDIVIDUAL NPI #