| NPI | 1174896914 |
|---|---|
| Other Name | TPAN |
| Entity Type | Organization |
| Authorized Contact | TANYA MAULDIN Provider Enrollment Manager 414-225-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2025-05-14 |