Healthcare Provider Details

I. General information

NPI: 1831754167
Provider Name (Legal Business Name): ASAP-BEHAVIORAL HEALTH, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11380 W THEODORE TRECKER WAY
WEST ALLIS WI
53214-1135
US

IV. Provider business mailing address

11380 W THEODORE TRECKER WAY
WEST ALLIS WI
53214-1135
US

V. Phone/Fax

Practice location:
  • Phone: 414-310-9685
  • Fax:
Mailing address:
  • Phone: 414-310-9685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER HARKIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 608-279-6879