MEDICARE: NEW BEGINNINGS MENTAL HEALTH CLINIC 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	3048	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	:	1720497308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BEGINNINGS MENTAL HEALTH CLINIC LLC.

Provider Business Mailing Address
First Line	:	6754 W BELOIT RD
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53219-2068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6754 W BELOIT RD
Second Line	:	STE 10
City	:	WEST ALLIS
State	:	WI
Zip	:	53219-2068
Country	:	US
Telephone Number	:	414-329-4673
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	RUTH KOHNKE
Credential	:
Telephone Number	:	414-329-4673

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/21/2014

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