Provider Demographics
NPI:1528486263
Name:ALAN SUMWALT PSYCHOTHERAPIES LLC
Entity type:Organization
Organization Name:ALAN SUMWALT PSYCHOTHERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUMWALT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LMFT
Authorized Official - Phone:414-588-6452
Mailing Address - Street 1:146 PARK AVE
Mailing Address - Street 2:PEWAUKEE, WI
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3410
Mailing Address - Country:US
Mailing Address - Phone:414-588-6452
Mailing Address - Fax:262-691-3005
Practice Address - Street 1:146 PARK AVE
Practice Address - Street 2:PEWAUKEE, WI
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3410
Practice Address - Country:US
Practice Address - Phone:414-588-6452
Practice Address - Fax:262-691-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI346-123261QM0850X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty