Provider Demographics
NPI:1366269987
Name:CENTER FOR INTEGRATIVE PSYCHIATRIC CARE, LLC
Entity type:Organization
Organization Name:CENTER FOR INTEGRATIVE PSYCHIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLARY
Authorized Official - Middle Name:DE'SHAUNN
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-232-8397
Mailing Address - Street 1:CIPC LLC AT FRESH START
Mailing Address - Street 2:500 W SILVER SPRING DR, SUITE K320
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209
Mailing Address - Country:US
Mailing Address - Phone:414-232-8397
Mailing Address - Fax:
Practice Address - Street 1:CIPC LLC AT FRESH START
Practice Address - Street 2:500 W SILVER SPRING DR, SUITE K320
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209
Practice Address - Country:US
Practice Address - Phone:414-232-8397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health