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General NPI Number Information
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NPI Number | 1285237958
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Entity Type | Organization
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Legal Business Name | DIFFERENT HORIZONS BEHAVIORAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 1337 N 30TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-2420
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Country | US
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Telephone | 414-394-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 1337 N 30TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53208-2420
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Country | US
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Telephone | 414-394-5517
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Fax |
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Authorized Official
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Title or Position | EXERCUTIVE DIRECTOR
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Name | MS. LATIKA NICOLE WASHINGTON
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Credential | CSAC, LPC-IT, ICS
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Telephone | 414-394-5517
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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 |
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License Number State |
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Taxonomy #2
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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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