Provider Demographics
NPI:1891375432
Name:NOVA MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:NOVA MENTAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAYLER
Authorized Official - Middle Name:SIMONE
Authorized Official - Last Name:CLARK-CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-213-9869
Mailing Address - Street 1:3034 S WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3017
Mailing Address - Country:US
Mailing Address - Phone:608-213-9869
Mailing Address - Fax:
Practice Address - Street 1:4465 N OAKLAND AVE STE 360
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-1681
Practice Address - Country:US
Practice Address - Phone:414-775-3278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty