Provider Demographics
NPI:1225779085
Name:ONE9 TRAUMA & BEHAVIORAL HEALTH COUNSELING SERVICES
Entity Type:Organization
Organization Name:ONE9 TRAUMA & BEHAVIORAL HEALTH COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-630-4986
Mailing Address - Street 1:4039 N 19TH PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6806
Mailing Address - Country:US
Mailing Address - Phone:414-630-4986
Mailing Address - Fax:414-988-4009
Practice Address - Street 1:4039 N 19TH PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6806
Practice Address - Country:US
Practice Address - Phone:414-630-4986
Practice Address - Fax:414-988-4009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty