Provider Demographics
NPI:1356036958
Name:BIENESTAR PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:BIENESTAR PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:414-324-8070
Mailing Address - Street 1:1433 N WATER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2603
Mailing Address - Country:US
Mailing Address - Phone:414-502-9006
Mailing Address - Fax:
Practice Address - Street 1:1433 N WATER ST STE 400
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2603
Practice Address - Country:US
Practice Address - Phone:414-502-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty