Basic Information
| Provider Information | |||||||||
| NPI: | 1093927147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEMENOS COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7441 WEST GREENFIELD AVENUE | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074433384 | ||||||||
| FaxNumber: | 7074433204 | ||||||||
| Practice Location | |||||||||
| Address1: | 7441 WEST GREENFIELD AVENUE | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074433384 | ||||||||
| FaxNumber: | 7074433204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | DIETZMAN | ||||||||
| AuthorizedOfficialFirstName: | DIANA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4147047370 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 1905 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 42183300 | 05 | WI | MEDICAID |