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General NPI Number Information
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NPI Number | 1831211309
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Entity Type | Organization
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Legal Business Name | ELMBROOK FAMILY COUNSELING CENTER LLP
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 12690 W NORTH AVE
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City | BROOKFIELD
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State | WI
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Zip | 53005-4636
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Country | US
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Telephone | 262-785-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 12690 W NORTH AVE
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City | BROOKFIELD
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State | WI
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Zip | 53005-4636
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Country | US
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Telephone | 262-785-9188
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. HOWARD J. HAVEN
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Credential | PH.D.
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Telephone | 262-785-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1297
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License Number State | WI
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