| NPI | 1447601778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA ANTHONY Director 262-212-4654 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: WI 3068) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 3068) |
| 101YM0800X Counselor Mental Health (Licence: WI 3068) | |
| 101YP2500X Counselor Professional (Licence: WI 3068) | |
| 103T00000X Psychologist (Licence: WI 3068) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: WI 3068) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: WI 3068) | |
| 103TC0700X Psychologist Clinical (Licence: WI 3068) | |
| 103TC1900X Psychologist Counseling (Licence: WI 3068) | |
| 103TF0000X Psychologist Family (Licence: WI 3068) | |
| 103TP0016X Psychologist Prescribing (Medical) (Licence: WI 3068) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: WI 3068) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: WI 3068) | |
| 1041C0700X Social Worker Clinical (Licence: WI 3068) | |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: WI 3068) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |