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General NPI Number Information
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NPI Number | 1174320634
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Entity Type | Organization
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Legal Business Name | HAPPY LIVING INTELLECTUAL CLINIC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 5202 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53210-2749
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Country | US
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Telephone | 414-795-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 5202 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53210-2749
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MRS. JEANETTE QUNEE' ALLEN
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Credential | PMHNP-BC
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Telephone | 414-795-7352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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