MEDICARE: ADKINS COUNSELING SERVICES, 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	251S00000X	Community/Behavioral Health Agency	14841-130	WI
2	251S00000X	Community/Behavioral Health Agency	4059 125	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1467699272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADKINS COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	6001 W CENTER ST
Second Line	:	SUTIE 208
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-393-1099
Fax Number	:	414-393-9773

Provider Business Practice Location Address
First Line	:	6001 W CENTER ST
Second Line	:	SUTIE 208
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-2154
Country	:	US
Telephone Number	:	414-393-1099
Fax Number	:	414-393-9773

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MS. MARCELLA SYVILLE ADKINS
Credential	:	LPC, SAC-IT
Telephone Number	:	414-573-0707

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	10/29/2010

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