Healthcare Provider Details

I. General information

NPI: 1891976478
Provider Name (Legal Business Name): FUTURE THOUGHTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2007
Last Update Date: 11/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 N 53RD ST
MILWAUKEE WI
53210-2326
US

IV. Provider business mailing address

2623 N 53RD ST
MILWAUKEE WI
53210-2326
US

V. Phone/Fax

Practice location:
  • Phone: 414-397-1559
  • Fax:
Mailing address:
  • Phone: 414-397-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DANIELLE CHELESE MCCLENDON
Title or Position: PRESIDENT/DIRECTOR
Credential:
Phone: 414-397-1559