| NPI | 1326489154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK GEORGE JACKSON Executive Director 414-393-0295 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: WI 2990) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2020-01-09 |