=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235112020
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHOLIC CHARITIES OF THE ARCHDIOCESE OF MILWAUKEE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7635 W OKLAHOMA AVE #104
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53219-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-541-3624
-----------------------------------------------------
Fax | 414-541-3624
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7635 W OKLAHOMA AVE #104
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53219-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-541-3624
-----------------------------------------------------
Fax | 414-541-0063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. GARY D HOWLEY
-----------------------------------------------------
Credential | MSW, LCSW
-----------------------------------------------------
Telephone | 414-769-3616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 2400
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------