Healthcare Provider Details

I. General information

NPI: 1487878500
Provider Name (Legal Business Name): M & S CLINICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N 4TH ST 516
MILWAUKEE WI
53212-2362
US

IV. Provider business mailing address

2821 N 4TH ST 516
MILWAUKEE WI
53212-2362
US

V. Phone/Fax

Practice location:
  • Phone: 414-263-6000
  • Fax: 414-263-2270
Mailing address:
  • Phone: 414-263-6000
  • Fax: 414-263-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1546
License Number StateWI

VIII. Authorized Official

Name: MARK STEVEN FOSSIE
Title or Position: CEO
Credential: MS, LMFT, CSAC, ICS
Phone: 414-263-6000