=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821450099
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATIN COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2016
-----------------------------------------------------
Last Update Date | 03/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 853 TAFT TER
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53027-9287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-600-1188
-----------------------------------------------------
Fax | 414-453-4253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6815 W CAPITOL DR SUITE 201
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53216-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-600-1188
-----------------------------------------------------
Fax | 414-453-4253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. SHARON MEDINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-600-1188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 7059
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------