Provider Demographics
NPI:1174331441
Name:NEXUS MOMENTUM PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:NEXUS MOMENTUM PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-367-8494
Mailing Address - Street 1:777 N JEFFERSON ST
Mailing Address - Street 2:STE 408 PMB 1250
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1924
Mailing Address - Country:US
Mailing Address - Phone:414-367-8494
Mailing Address - Fax:
Practice Address - Street 1:2135 N 63RD ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2054
Practice Address - Country:US
Practice Address - Phone:414-367-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty