=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902790264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER HEIGHTS COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 E WISCONSIN AVE #1800-0142
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53202-0114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-356-2866
-----------------------------------------------------
Fax | 414-413-2003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2116 E HOLT AVE
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53207-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-408-7442
-----------------------------------------------------
Fax | 414-413-2003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER/CEO
-----------------------------------------------------
Name | MR. RYAN PATRICK BUFTON
-----------------------------------------------------
Credential | MSW CAPSW
-----------------------------------------------------
Telephone | 414-356-2866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------