| S.m.i.l.e. Inc. Mental Health & Aoda Outpatient Clinic | |
|
4222 W Capitol Dr Ste 308 Milwaukee WI 53216-2500 | |
| (262) 343-5609 | |
| Not Available |
| Full Name | S.m.i.l.e. Inc. Mental Health & Aoda Outpatient Clinic |
|---|---|
| Speciality | Counselor |
| Location | 4222 W Capitol Dr Ste 308, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Annette L Veasey (PRESIDENT/CEO) |
| Authorized Official Contact | 2623435609 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| S.m.i.l.e. Inc. Mental Health & Aoda Outpatient Clinic 4222 W Capitol Dr Ste 308 Milwaukee WI 53216-2500 Ph: (262) 343-5609 | S.m.i.l.e. Inc. Mental Health & Aoda Outpatient Clinic 4222 W Capitol Dr Ste 308 Milwaukee WI 53216-2500 Ph: (262) 343-5609 |
| NPI Number | 1851831473 |
|---|---|
| Provider Enumeration Date | 03/01/2017 |
| Last Update Date | 10/10/2018 |
| Medicare PECOS PAC ID | 8022355353 |
|---|---|
| Medicare Enrollment ID | O20190124002660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851831473 | NPI | - | NPPES |
| 100077100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| Provider Name | Edward G Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700062155 PECOS PAC ID: 8921179979 Enrollment ID: I20080618000448 |
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