Provider Demographics
NPI:1356569115
Name:APPLIED THERAPIES & WELLNESS CENTER, S.C.
Entity type:Organization
Organization Name:APPLIED THERAPIES & WELLNESS CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT-S
Authorized Official - Phone:414-302-1233
Mailing Address - Street 1:150 N. SUNNYSLOPE RD. STE 372
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4806
Mailing Address - Country:US
Mailing Address - Phone:414-302-1233
Mailing Address - Fax:262-788-9662
Practice Address - Street 1:150 N. SUNNYSLOPE RD. STE 372
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4806
Practice Address - Country:US
Practice Address - Phone:414-302-1233
Practice Address - Fax:262-788-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6747-1231041C0700X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1356569115Medicaid