Premier Medical & Couple Therapy

Primary specialty

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

Legal business name

PREMIER MEDICAL & COUPLE THERAPY

Practice address

1025 W Glen Oaks LN Ste 208
Mequon, WI 53092-3374

Phone

(262) 957-6159

NPI assigned

Jul 30, 2020

Last updated

Jul 30, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeanine Marie Swenson, MD, LMFT

Title

Director & Owner

Phone

(262) 957-6159

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1629687108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 W GLEN OAKS LN STE 208",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923374",
            "telephone_number": "262-957-6159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 W GLEN OAKS LN STE 208",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923374",
            "telephone_number": "262-957-6159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL & COUPLE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "JEANINE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR & OWNER",
        "authorized_official_telephone_number": "262-957-6159",
        "authorized_official_credential": "MD, LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G17772",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Mequon, WI
• Providers in Mequon, 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 Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.