Third Wave Psychotherapy & Assessment, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

THIRD WAVE PSYCHOTHERAPY & ASSESSMENT, LLC

Practice address

2180 S 87TH St
West Allis, WI 53227-1720

Phone

(414) 215-0017

NPI assigned

Oct 24, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Kristen Payne, PHDNPI 1427492347

Title

Psychologist/Owner

Phone

(414) 215-0017

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

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

• Kristen L Payne, PH.D.

  • Clinical Psychologist
  • Lubbock, TX
  • NPI 1427492347

  WI

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1295556975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 S 87TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 S 87TH ST",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532271720",
            "telephone_number": "414-215-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD WAVE PSYCHOTHERAPY & ASSESSMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "414-215-0017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1427492347",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theresa Pardoe D.O.
• Ruth M Thielen, CCC SLP
• Angelina Marie Thieme-House
• Lisa S Thill, MSW, LCSW
• Third Coast Dental LLC
• Leah Thoma
• Lashawna Thomas
• Elizabeth C Thompson, MD
• Timothy J Thompson, MD
• Kristin Jeanne Thomson, MS, CSAC, LPC-IT

• Mental Health Counselor in West Allis, WI
• Providers in West Allis, WI by specialty
• Mental Health Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.