Provider Demographics
NPI:1013212810
Name:MILWAUKEE COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MILWAUKEE COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR MENTAL H
Authorized Official - Prefix:MS
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:414-257-7377
Mailing Address - Street 1:9201 W WATERTOWN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3558
Mailing Address - Country:US
Mailing Address - Phone:414-257-7377
Mailing Address - Fax:414-454-4242
Practice Address - Street 1:9201 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3558
Practice Address - Country:US
Practice Address - Phone:414-257-7377
Practice Address - Fax:414-454-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10062926Medicaid