Myles Tonnacliff PH.D, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

2163-57 Issued in WI

Legal business name

MYLES TONNACLIFF PH.D, LLC

Practice address

W62N248 Washington Ave
Suite 208
Cedarburg, WI 53012-2768

Phone

(262) 618-2856

NPI assigned

May 11, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Myles D Tonnacliff, LPNPI 1942335260

Title

Licesed Psychologist- Owner

Phone

(262) 618-2856

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Myles D Tonnacliff, PHD

  • Psychologist
  • Cedarburg, WI
  • NPI 1942335260
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1235666017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W62N248 WASHINGTON AVE",
            "address_2": "SUITE 208",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122768",
            "telephone_number": "414-617-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W62N248 WASHINGTON AVE",
            "address_2": "SUITE 208",
            "city": "CEDARBURG",
            "state": "WI",
            "postal_code": "530122768",
            "telephone_number": "262-618-2856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYLES TONNACLIFF PH.D, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "TONNACLIFF",
        "authorized_official_first_name": "MYLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "LICESED PSYCHOLOGIST- OWNER",
        "authorized_official_telephone_number": "262-618-2856",
        "authorized_official_credential": "LP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "WI",
            "license": "2163-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Cedarburg, WI
• Providers in Cedarburg, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.