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NPI Code Detail

MEDICARE: MR. BRIAN LEE GROESCHEL LPC, CSAC

MEDICARE:  MR. BRIAN LEE GROESCHEL  LPC, CSAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor15461-132WI
2101YP2500XProfessional Counselor4566-125WI

General Provider Information

NPI Number : 1649404039
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN LEE GROESCHEL LPC, CSAC
Provider Business Mailing Address
First Line : 1111 S 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-2301
Country : US
Telephone Number : 414-643-8530
Fax Number : 414-647-8602
Provider Business Practice Location Address
First Line : 1111 S 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53204-2301
Country : US
Telephone Number : 414-643-8530
Fax Number : 414-647-8602
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2009
Last Update Date : 02/15/2017

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Directions to “ MR. BRIAN LEE GROESCHEL LPC, CSAC” Practice Location

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