Healthcare Provider Details

I. General information

NPI: 1255371142
Provider Name (Legal Business Name): JAMES LOUIS HARRISON III MS, CSAC, LPC, NCGC-
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 W NATIONAL AVE STE 108
NEW BERLIN WI
53151-5158
US

IV. Provider business mailing address

10012 WEST CAPITOL DRIVE, SUITE 101 WEST GROVE CLINIC, LLC
WAUWATOSA WI
53222
US

V. Phone/Fax

Practice location:
  • Phone: 262-249-6565
  • Fax: 262-910-5477
Mailing address:
  • Phone: 414-810-4844
  • Fax: 414-810-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13018
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: