EBB TIDE THERAPY
NPI 1720353741
Social Worker - Clinical in Milwaukee, WI

Active since March 09, 2012
2821 N 4TH ST STE 209, MILWAUKEE, WI 53212(414) 372-7212(414) 372-7213 Get Directions Write a Review

NPPES record last updated: July 5, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Ebb Tide Therapy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBB TIDE THERAPY (NPI 1720353741) is a healthcare organization registered as a clinical in Milwaukee, Wisconsin and active in the NPI registry since March 2012. The organization lists Shannon Gae O'brien, Therapist, as its authorized official.

NPPES Registry Identity

NPI1720353741
Entity TypeOrganization
Primary Taxonomy1041C0700X
Legal Business NameEBB TIDE THERAPY
Location Address2821 N 4TH ST STE 209Milwaukee, WI 53212-2367
Mailing Address2821 N 4th St Ste 209Milwaukee, WI 53212-2367 · (414) 372-7212 · Fax (414) 372-7213
Fax(414) 372-7213
Organization SubpartNo
Authorized OfficialShannon Gae O'brienTherapist · (414) 372-7212
Enumeration DateMarch 9, 2012
Last NPPES UpdateJuly 5, 2012
NPI 1720353741 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License Licensed in WI · 7197-123
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 1971-132
2821 N 4TH ST STE 209, Milwaukee, WI 53212

Other Identifiers 1

Medicaid1366529182WI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebb Tide Therapy's NPI number?

The NPI number for Ebb Tide Therapy is 1720353741. It was assigned to this organization in the NPPES registry on March 9, 2012.

Where is Ebb Tide Therapy located?

Ebb Tide Therapy is located at 2821 N 4th St Ste 209, Milwaukee, WI 53212. The listed phone number is (414) 372-7212.

What is Ebb Tide Therapy's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Ebb Tide Therapy was last updated on July 5, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.