Healthcare Provider Details

I. General information

NPI: 1164673133
Provider Name (Legal Business Name): FOKUS FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N VEL R PHILLIPS AVE STE 123
MILWAUKEE WI
53212-2370
US

IV. Provider business mailing address

2821 N VEL R PHILLIPS AVE STE 123
MILWAUKEE WI
53212-2370
US

V. Phone/Fax

Practice location:
  • Phone: 414-264-4217
  • Fax: 414-264-4218
Mailing address:
  • Phone: 414-264-4217
  • Fax: 414-264-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number52D2043078
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2473
License Number StateWI

VIII. Authorized Official

Name: MS. ELZORA DARLENE COLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: BS,CSAC-ICS
Phone: 414-264-4217