Provider Demographics
NPI:1063609584
Name:INNOVATIVE PSYCHOLOGY SERVICES, LLC
Entity type:Organization
Organization Name:INNOVATIVE PSYCHOLOGY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:414-732-3172
Mailing Address - Street 1:7635 W OKLAHOMA AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3600
Mailing Address - Country:US
Mailing Address - Phone:414-732-3172
Mailing Address - Fax:414-386-4632
Practice Address - Street 1:7635 W OKLAHOMA AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53219-3600
Practice Address - Country:US
Practice Address - Phone:414-732-3172
Practice Address - Fax:414-386-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2456-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty