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

Table of content: (NPI 1245238633)

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: 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" .
  • 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" .

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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