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General NPI Number Information
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NPI Number | 1962577767
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Entity Type | Organization
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Legal Business Name | WISCONSIN COMMUNITY MENTAL HEALTH COUNSELING CENTERS INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 04/14/2010
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Provider Practice Location Address
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Address Line | 10532 N PORT WASHINGTON RD SUITE 1 B
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City | MEQUON
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State | WI
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Zip | 53092
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Country | US
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Telephone | 262-242-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 10532 N PORT WASHINGTON RD SUITE 1B
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City | MEQUON
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State | WI
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Zip | 53092-5563
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Country | US
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Telephone | 262-242-3810
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR OWNER
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Name | MR. LAWRENCE A KANE III
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Credential | LCSW LPC CADC MAC RC
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Telephone | 262-242-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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