Healthcare Provider Details

I. General information

NPI: 1285005082
Provider Name (Legal Business Name): JOHN VIANNEY MUWEESI LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 N GREEN BAY AVE UPPR LEVEL
GLENDALE WI
53209-3811
US

IV. Provider business mailing address

6025 N GREEN BAY AVE UPPR LEVEL
GLENDALE WI
53209-3811
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-0801
  • Fax: 414-247-0816
Mailing address:
  • Phone: 414-247-0801
  • Fax: 414-247-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6367
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: