MEDICARE: THE COUNSELING CENTER OF MILWAUKEE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	HFS 61.91	WI
2	104100000X	Social Worker	HFS 61.91	WI
3	1041C0700X	Clinical Social Worker	HFS 61.91	WI
4	106H00000X	Marriage & Family Therapist	HFS 61.91	WI
5	103TC1900X	Counseling Psychologist	HFS 61.91	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	HFS 61.91	OTHER	WI	CLINIC LICENSE NUMBER

General Provider Information

NPI Number	:	1245238633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COUNSELING CENTER OF MILWAUKEE, INC.

Provider Business Mailing Address
First Line	:	4200 N HOLTON ST
Second Line	:	SUITE 400
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1064
Country	:	US
Telephone Number	:	414-964-2565
Fax Number	:	414-964-0102

Provider Business Practice Location Address
First Line	:	4200 N HOLTON ST
Second Line	:	SUITE 400
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1064
Country	:	US
Telephone Number	:	414-964-2565
Fax Number	:	414-964-0102

Authorized Official
Title or Position	:	VICE PRESIDENT OF CLINICAL SERVICES
Name	:	MS. CATHY ARNEY
Credential	:	LCSW, LMFT
Telephone Number	:	414-271-2565

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	08/16/2010

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