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General NPI Number Information
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NPI Number | 1467813956
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Entity Type | Organization
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Legal Business Name | INNER CITY BEHAVIOR SERVICES, LLC
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Dates
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Enumeration Date | 03/11/2016
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Last Update Date | 03/11/2016
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Provider Practice Location Address
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Address Line | 4738 W LISBON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53208-2416
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Country | US
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Telephone | 414-249-3571
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Fax | 414-249-3876
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Provider Business Mailing Address
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Address Line | 4738 W LISBON AVE STE 8
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City | MILWAUKEE
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State | WI
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Zip | 53208-1127
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Country | US
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Telephone | 414-249-3571
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Fax | 414-249-3876
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Authorized Official
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Title or Position | CEO
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Name | BARBARA TRIPP
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Credential | LPC
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Telephone | 414-249-3571
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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 | 5949-125
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License Number State | WI
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