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NPI Code Detail

MEDICARE: MINDSTAR COUNSELING, LLC.

MEDICARE: MINDSTAR COUNSELING, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346579653
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDSTAR COUNSELING, LLC.
Provider Business Mailing Address
First Line : PO BOX 1115
Second Line :
City : MENOMONEE FALLS
State : WI
Zip : 53052-1115
Country : US
Telephone Number : 414-435-1115
Fax Number : 414-435-0543
Provider Business Practice Location Address
First Line : 4025 N 92ND ST
Second Line :
City : WAUWATOSA
State : WI
Zip : 53222-1613
Country : US
Telephone Number : 414-435-1115
Fax Number : 414-435-0543
Authorized Official
Title or Position : CLINIC ADMINISTRATOR
Name : DR. STARLETTE MARIE PATTERSON
Credential : PHD
Telephone Number : 414-435-1115
Provider Enumeration Date : 12/15/2009
Last Update Date : 02/21/2023

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Directions to “MINDSTAR COUNSELING, LLC. ” Practice Location

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