Provider Demographics
NPI:1588710073
Name:SHORE COUNSELING AND CONSULTING CLINIC, S.C.
Entity type:Organization
Organization Name:SHORE COUNSELING AND CONSULTING CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TROAST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-771-9304
Mailing Address - Street 1:2600 N MAYFAIR RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-1309
Mailing Address - Country:US
Mailing Address - Phone:414-771-9304
Mailing Address - Fax:414-771-9543
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:SUITE 650
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1309
Practice Address - Country:US
Practice Address - Phone:414-771-9304
Practice Address - Fax:414-771-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42247200Medicaid