MEDICARE: D & S HEALING CENTER

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	101Y00000X	Counselor	2555-125	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2555-125	WI
3	101YP2500X	Professional Counselor	2555-125	WI
4	101YM0800X	Mental Health Counselor	2555-125	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	:	1790010718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D & S HEALING CENTER

Provider Business Mailing Address
First Line	:	2568 N MARTIN LUTHER KING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2710
Country	:	US
Telephone Number	:	414-265-0300
Fax Number	:	414-265-0200

Provider Business Practice Location Address
First Line	:	2568 N MARTIN LUTHER KING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2710
Country	:	US
Telephone Number	:	414-265-0300
Fax Number	:	414-265-0200

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TRACY TREACY
Credential	:
Telephone Number	:	414-265-0300

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	10/08/2009

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Directions to “D & S HEALING CENTER ” Practice Location

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