Healthcare Provider Details

I. General information

NPI: 1982929261
Provider Name (Legal Business Name): THERAPY AND CONSULTING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 95TH ST
MILWAUKEE WI
53226-4435
US

IV. Provider business mailing address

500 N 95TH ST
MILWAUKEE WI
53226-4435
US

V. Phone/Fax

Practice location:
  • Phone: 414-915-6167
  • Fax:
Mailing address:
  • Phone: 414-915-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. LAURO GUZMAN
Title or Position: OWNER
Credential: LCSW
Phone: 414-915-6167