MEDICARE: OPEN DOOR COUNSELING AND WELLNESS LLC

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

General Provider Information

NPI Number	:	1902734387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN DOOR COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	9205 W CENTER ST STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4548
Country	:	US
Telephone Number	:	414-563-7341
Fax Number	:	262-474-3659

Provider Business Practice Location Address
First Line	:	9205 W CENTER ST STE 201
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-4548
Country	:	US
Telephone Number	:	414-563-7341
Fax Number	:	262-474-3659

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. ROBIN GAYLE BLOCK
Credential	:	MS, LPC
Telephone Number	:	262-689-9674

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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