Healthcare Provider Details

I. General information

NPI: 1255112751
Provider Name (Legal Business Name): MAHOGANY HEART COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7384 N 60TH ST
MILWAUKEE WI
53223-4602
US

IV. Provider business mailing address

7384 N 60TH ST
MILWAUKEE WI
53223-4602
US

V. Phone/Fax

Practice location:
  • Phone: 414-865-3456
  • Fax:
Mailing address:
  • Phone: 414-865-3456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHUNTEL WEBB
Title or Position: OWNER
Credential:
Phone: 414-865-3456