MEDICARE: ZENA COUNSELING CENTER OF MILWAUKEE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6820	OTHER	WI	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053882373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZENA COUNSELING CENTER OF MILWAUKEE LLC

Provider Business Mailing Address
First Line	:	PO BOX 639
Second Line	:
City	:	THIENSVILLE
State	:	WI
Zip	:	53092-0639
Country	:	US
Telephone Number	:	414-247-9005
Fax Number	:	414-247-9004

Provider Business Practice Location Address
First Line	:	3927 S HOWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-4421
Country	:	US
Telephone Number	:	844-458-4201
Fax Number	:	414-247-9004

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	AZIZA O DAHER
Credential	:	LPC
Telephone Number	:	414-247-9005

Provider Enumeration Date	:	12/14/2018
Last Update Date	:	10/04/2021

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