Healthcare Provider Details

I. General information

NPI: 1225352768
Provider Name (Legal Business Name): GUEST HOUSE OF MILWAUKEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N 13TH ST
MILWAUKEE WI
53205-2515
US

IV. Provider business mailing address

1216 N 13TH ST
MILWAUKEE WI
53205-2515
US

V. Phone/Fax

Practice location:
  • Phone: 414-345-3240
  • Fax: 414-345-3258
Mailing address:
  • Phone: 414-345-3240
  • Fax: 414-345-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KENYATTA MATTHEWS
Title or Position: VP OF CLINIC OPERATIONS
Credential:
Phone: 414-430-0970