1245238633 NPI number — THE COUNSELING CENTER OF MILWAUKEE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245238633 NPI number — THE COUNSELING CENTER OF MILWAUKEE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COUNSELING CENTER OF MILWAUKEE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245238633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 N HOLTON ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53212-1064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-964-2565
Provider Business Mailing Address Fax Number:
414-964-0102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 N HOLTON ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53212-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-964-2565
Provider Business Practice Location Address Fax Number:
414-964-0102
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARNEY
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF CLINICAL SERVICES
Authorized Official Telephone Number:
414-271-2565

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  HFS 61.91 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: HFS 61.91 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: HFS 61.91 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: HFS 61.91 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: HFS 61.91 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 42197100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HFS 61.91 . This is a "CLINIC LICENSE NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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