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General NPI Number Information
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NPI Number | 1790169522
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Entity Type | Organization
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Legal Business Name | HOPES CENTER
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 07/10/2015
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Provider Practice Location Address
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Address Line | 521 6TH ST
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City | RACINE
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State | WI
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Zip | 53403-1117
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Country | US
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Telephone | 262-898-2940
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Fax | 262-898-1772
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Provider Business Mailing Address
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Address Line | 1140 S 119TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53214-2135
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Country | US
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Telephone | 414-510-6084
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MRS. DEBERAH KAY PETERSON
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Credential | LCSW
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Telephone | 414-510-6084
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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 | 4100-123
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License Number State | WI
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