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General NPI Number Information
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NPI Number | 1154574549
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Entity Type | Organization
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Legal Business Name | OMNI ENRICHMENT, INCORPORATION
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 02/13/2015
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Provider Practice Location Address
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Address Line | 3020 W VLIET ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-2461
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Country | US
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Telephone | 414-312-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 3020 W VLIET ST 3897 N. 40TH STREET
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City | MILWAUKEE
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State | WI
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Zip | 53208-2461
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Country | US
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Telephone | 414-312-8910
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/THERAPIST
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Name | MRS. BARBARA ANN TRIPP
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Credential | M.S., CSAC,LPC-IT
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Telephone | 414-312-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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