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General NPI Number Information
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NPI Number | 1962891994
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Entity Type | Organization
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Legal Business Name | KLS COMMUNITY OUTREACH TEEN CENTER CONSULTING AND MANAGEMENT L.L.C.
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 8330 NORTH TEUTONIA AVE SUITE 103
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City | BROWN DEER
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State | WI
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Zip | 53209
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Country | US
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Telephone | 414-236-5278
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Fax | 414-368-3051
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Provider Business Mailing Address
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Address Line | 8330 NORTH TEUTONIA AVE SUITE 103
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City | BROWN DEER
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State | WI
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Zip | 53209
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Country | US
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Telephone | 414-236-5278
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Fax | 414-368-3051
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Authorized Official
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Title or Position | CEO
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Name | MRS. KENYA LATRICE SMITH
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Credential |
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Telephone | 414-236-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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