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General NPI Number Information
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NPI Number | 1609997683
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Entity Type | Organization
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Legal Business Name | CHILD ADOLESCENT FAMILY MARRIAGE THERAPY ASSOCIATES
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 230 W WELLS ST SUITE 630
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-272-5005
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Fax | 414-272-3760
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Provider Business Mailing Address
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Address Line | 230 W WELLS ST SUITE 630
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City | MILWAUKEE
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State | WI
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Zip | 53203-1866
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Country | US
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Telephone | 414-272-5005
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Fax | 414-272-3760
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MS. EMMA WILLIAMS
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Credential | LCSW, LMFT
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Telephone | 414-272-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3168-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 249-124
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1934-123
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License Number State | WI
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