Provider Demographics
NPI:1912093162
Name:URTZ, FRANK PAUL (PHD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:PAUL
Last Name:URTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 N PORT WASHINGTON RD
Mailing Address - Street 2:CLEAR DIRECTION PSYCHOLOGICAL SERVICES, INC.
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4308
Mailing Address - Country:US
Mailing Address - Phone:414-332-3390
Mailing Address - Fax:414-332-3392
Practice Address - Street 1:6110 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4308
Practice Address - Country:US
Practice Address - Phone:414-332-3390
Practice Address - Fax:414-332-3392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI841057103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI522413716013OtherBLUE CROSS BLUE SHIELD
WI4017291OtherAETNA PROVIDER NUMBER
WI157211OtherVALUEOPTIONS PROVIDER
WI39020900Medicaid
WI166708OtherMANAGED HEALTH NETWORK
WI522413716013OtherBLUE CROSS BLUE SHIELD
WIR76833Medicare UPIN
WI000084827Medicare PIN