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4117 N Green Bay Ave Milwaukee WI 53209-7019 | |
(414) 433-0780 | |
(414) 433-5780 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4117 N Green Bay Ave, Milwaukee, Wisconsin |
Authorized Official Name and Position | Amber Ellis (OWNER) |
Authorized Official Contact | 4142188670 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4117 N Green Bay Ave Milwaukee WI 53209-7019 Ph: (414) 218-8670 | 4117 N Green Bay Ave Milwaukee WI 53209-7019 Ph: (414) 433-0780 |
NPI Number | 1306587167 |
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Provider Enumeration Date | 04/05/2022 |
Last Update Date | 06/06/2024 |
Certification Date | 01/18/2024 |
Medicare PECOS PAC ID | 4688022700 |
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Medicare Enrollment ID | O20231130001629 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306587167 | NPI | - | NPPES |
1760613327 | Medicaid | WI |
Provider Name | Yasmine Michelle Morton |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1043839517 PECOS PAC ID: 4880131259 Enrollment ID: I20240802001098 |
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