| NPI | 1528160314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BASILISA VIRELLA Director 414-347-7063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: WI 2692-123) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WI 27318020) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-08-22 |