Healthcare Provider Details

I. General information

NPI: 1902734387
Provider Name (Legal Business Name): OPEN DOOR COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W CENTER ST STE 201
MILWAUKEE WI
53222-4548
US

IV. Provider business mailing address

9205 W CENTER ST STE 201
MILWAUKEE WI
53222-4548
US

V. Phone/Fax

Practice location:
  • Phone: 414-563-7341
  • Fax: 262-474-3659
Mailing address:
  • Phone: 414-563-7341
  • Fax: 262-474-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

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