MEDICARE: COPE BEHAVIORAL SERVICES, INC.

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	2587	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831234012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COPE BEHAVIORAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	2821 N 4TH ST
Second Line	:	SUITE # 121
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2362
Country	:	US
Telephone Number	:	414-265-5112
Fax Number	:	414-265-4140

Provider Business Practice Location Address
First Line	:	2821 N 4TH ST
Second Line	:	SUITE # 121
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2362
Country	:	US
Telephone Number	:	414-265-5112
Fax Number	:	414-265-4140

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	DAVID A. GUYTON
Credential	:
Telephone Number	:	414-265-5087

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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