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General NPI Number Information
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NPI Number | 1154594406
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Entity Type | Organization
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Legal Business Name | MILWAUKEE MENTAL HEALTH ASSOCIATES, INC.
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 3975 N 68TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216-2066
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Country | US
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Telephone | 414-873-1960
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Fax |
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Provider Business Mailing Address
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Address Line | 3975 N. 68TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53216
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Country | US
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Telephone | 414-873-1960
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CHANTIL HARRIS
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Credential | LCSW
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Telephone | 414-873-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2739
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License Number State | WI
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