Basic Information
| Provider Information | |||||||||
| NPI: | 1528342037 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRSH | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSMFT, SAC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147445370 | ||||||||
| FaxNumber: | 4147449052 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4147445370 | ||||||||
| FaxNumber: | 4147449052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 02/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 246-228 | WI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | 16478-130 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.