| NPI | 1750729984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LEE DAVISON Clinical Psychotherapist 414-491-2140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7889-123) |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2013-06-10 |