Organization Name: | OZAUKEE COMMUNITY THERAPIES LLC |
NPI Number: | 1144607169 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIN C PEREZ (OWNER/DIRECTOR) |
Mailing Address: | 101 Falls Rd Suite 403 Grafton |
State: | WI US |
Postal Code: | 530242612 |
Phone Number: | 4145590050 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2015 |
NPI Last Update Date: | 04/28/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5058 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |