Provider Demographics
NPI:1699764167
Name:GARLAND, THOMAS A IV (PSYD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:GARLAND
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 S WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1932
Mailing Address - Country:US
Mailing Address - Phone:414-483-0558
Mailing Address - Fax:
Practice Address - Street 1:633 W WISCONSIN AVE
Practice Address - Street 2:SUITE #1810
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1918
Practice Address - Country:US
Practice Address - Phone:414-271-3322
Practice Address - Fax:414-271-2335
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2722-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40971900Medicaid