Doctor Name: | MATTHEW LEE VELISSARIS |
NPI Number: | 1013341221 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 1942-226 |
Business Practice Address: | 4001 W Capitol Dr Milwaukee, WI - 532162530 |
Business Phone Number: | 4147595193 |
Business Fax Number: | |
Mailing Address: | 4929 W Fond Du Lac Ave, M MILWAUKEE |
State: | WI |
Postal Code: | 532162324 |
Phone Number: | 4148716122 |
Fax Number: | 4148712552 |
NPI Enumeration Date: | 08/23/2013 |
NPI Last Update Date: | 06/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 1942-226 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |