Healthcare Provider Details

I. General information

NPI: 1720990930
Provider Name (Legal Business Name): 360 SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 N 124TH ST APT 458
WAUWATOSA WI
53226-1053
US

IV. Provider business mailing address

2578 N 124TH ST APT 458
WAUWATOSA WI
53226-1053
US

V. Phone/Fax

Practice location:
  • Phone: 414-803-6422
  • Fax:
Mailing address:
  • Phone: 414-803-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JERMESHA WEST
Title or Position: OWNER/MENTAL HEALTH THERAPIST
Credential: LPC
Phone: 608-352-0243