Healthcare Provider Details

I. General information

NPI: 1578755237
Provider Name (Legal Business Name): ADULT CHILD & FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FALLS RD #404
GRAFTON WI
53204-2612
US

IV. Provider business mailing address

101 FALLS RD #404
GRAFTON WI
53204-2612
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-8441
  • Fax: 262-546-0005
Mailing address:
  • Phone: 262-375-8441
  • Fax: 262-546-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY HELEN LILLICH
Title or Position: OWNER
Credential: PHD
Phone: 262-375-8441