Ebb Tide Therapy

LBN: Ebb Tide Therapy
Ebb Tide Therapy is an health care organization with primary practice located at 2821 N 4Th St Ste 209 , Milwaukee WI 53212-2367. The organization recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is the primary health care specialty. Ebb Tide Therapy can be contacted via phone (414) 372-7212, or through O'Brien, Shannon Gae via phone (414) 372-7212.

Contact Information

Primary practice address
2821 N 4Th St Ste 209 Milwaukee WI 53212-2367
Phone: (414) 372-7212
Fax: (414) 372-7213
Website:
Map and Directions
Authorized official contact:
Name: O'Brien, Shannon Gae LCSW, CSAC, CTS
Phone: (414) 372-7212

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1971-132
Behavioral Health & Social Service Providers / Clinical 1041C0700X 7197-123 Wisconsin

Profile Details

NPI number 1720353741
LBN Legal business name Ebb Tide Therapy
DBA Doing business as
Authorized official O'Brien, Shannon Gae LCSW, CSAC, CTS
Entity Organization
Organization subpart 1 No
Enumeration date Mar 9th, 2012
Last updated Jul 5th, 2012 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720353741 NPPES
Wisconsin MEDICAID 1366529182

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