Ebb Tide Therapy

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7197-123 Issued in WI

Legal business name

EBB TIDE THERAPY

Practice address

2821 N 4TH St Ste 209
Milwaukee, WI 53212-2367

Phone

(414) 372-7212

Fax

(414) 372-7213

NPI assigned

Mar 9, 2012

Organization subpart

No

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

Authorized official

Name

Ms. Shannon Gae O'Brien, LCSW, CSAC, CTS

Title

Therapist

Phone

(414) 372-7212

Specialties & licenses 2

Addresses

Other identifiers 1

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

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341446400000",
    "number": "1720353741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 N 4TH ST STE 209",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122367",
            "telephone_number": "414-372-7212",
            "fax_number": "414-372-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 N 4TH ST STE 209",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122367",
            "telephone_number": "414-372-7212",
            "fax_number": "414-372-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBB TIDE THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-09",
        "last_updated": "2012-07-05",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "GAE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "414-372-7212",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW, CSAC, CTS"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": "1971-132",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "7197-123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366529182",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Easyliving Home Care Nu2U
• Hannah Eaton
• Jefflyn Eaton, R.N.
• Myrtle Faye Eaton, PTA
• Kendra Eaves, MS
• Margaret A Ebbott, RDH
• Mark Gerhard Eberhage, PHD
• David G Eberle, PHARMD
• Rachel Eberle
• Hannah Kristine Ebert, MD

• Clinical Social Worker in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; 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.