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General NPI Number Information
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NPI Number | 1629244983
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Entity Type | Organization
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Legal Business Name | EASTLAKE COUNSELING AND CONSULTING II
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 135 W WELLS ST SUITE 226
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City | MILWAUKEE
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State | WI
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Zip | 53203-1830
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Country | US
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Telephone | 414-272-0123
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Fax | 414-272-3498
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Provider Business Mailing Address
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Address Line | 135 W WELLS ST SUITE 226
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City | MILWAUKEE
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State | WI
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Zip | 53203-1830
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Country | US
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Telephone | 414-272-0123
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Fax | 414-272-3498
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Authorized Official
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Title or Position | CO DIRECTOR
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Name | MRS. MARY BETH SHAFFER
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Credential | LCSW
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Telephone | 414-272-0123
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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 |
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License Number State | WI
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