| NPI | 1942735766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER BRUNZELLE Executive Director 262-420-9088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 207QA0401X Family Medicine Addiction Medicine | |
| 261Q00000X Clinic/Center | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2023-05-22 |