| NPI | 1174896914 |
|---|---|
| Other Name | TPAN |
| Entity Type | Organization |
| Authorized Contact | TANYA MAULDIN Provider Enrollment Manager 414-225-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2023-07-19 |