Healthcare Provider Details

I. General information

NPI: 1568620466
Provider Name (Legal Business Name): GENESIS BEHAVIORAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST SUITE 2210
WEST ALLIS WI
53214-5647
US

IV. Provider business mailing address

6737 W WASHINGTON ST SUITE 2210
WEST ALLIS WI
53214-5647
US

V. Phone/Fax

Practice location:
  • Phone: 414-777-1570
  • Fax:
Mailing address:
  • Phone: 414-777-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: SCOTT DAVID HUNTINGTON
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: MA,LPC,CSAC,ICS
Phone: 414-588-9062