Healthcare Provider Details

I. General information

NPI: 1912566464
Provider Name (Legal Business Name): AMERICAN RELAXATION COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 06/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W BROWN DEER RD STE 106
BROWN DEER WI
53223-2346
US

IV. Provider business mailing address

5600 W BROWN DEER RD STE 106
BROWN DEER WI
53223-2346
US

V. Phone/Fax

Practice location:
  • Phone: 414-446-8154
  • Fax:
Mailing address:
  • Phone: 414-446-8154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAPHAEL FORD
Title or Position: DIRECTOR
Credential: MA
Phone: 414-517-7607