MEDICARE: MR. JUAN CORRAL JR. M.S., LPC

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	101YM0800X	Mental Health Counselor	12199-125	WI
2	101YM0800X	Mental Health Counselor	7139-226	WI

General Provider Information

NPI Number	:	1447961123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN CORRAL JR. M.S., LPC

Provider Business Mailing Address
First Line	:	5508 W VLIET ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2120
Country	:	US
Telephone Number	:	262-450-5767
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 W VLIET ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2120
Country	:	US
Telephone Number	:	262-450-5767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/04/2025

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