Provider Demographics
NPI:1386048551
Name:TARVID COUNSELING LLC
Entity type:Organization
Organization Name:TARVID COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT/MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TARVID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-491-0377
Mailing Address - Street 1:7670 W HONEY CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2738
Mailing Address - Country:US
Mailing Address - Phone:414-491-0377
Mailing Address - Fax:
Practice Address - Street 1:740 PILGRIM PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2066
Practice Address - Country:US
Practice Address - Phone:414-491-0377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7099-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40967200Medicaid