Healthcare Provider Details

I. General information

NPI: 1770721607
Provider Name (Legal Business Name): VIVENT HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N 6TH ST
MILWAUKEE WI
53212-4006
US

IV. Provider business mailing address

PO BOX 18412
PALATINE IL
60055-8440
US

V. Phone/Fax

Practice location:
  • Phone: 414-223-6800
  • Fax: 414-273-2357
Mailing address:
  • Phone: 866-525-5484
  • Fax: 833-394-4961

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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOANN BERK
Title or Position: SR. DIRECTOR OF CORPORATE SERVICES
Credential:
Phone: 414-225-1568