Provider Demographics
NPI:1235485012
Name:ALLIANCE INDIVIDUAL & FAMILY SERVICES
Entity Type:Organization
Organization Name:ALLIANCE INDIVIDUAL & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:414-355-5594
Mailing Address - Street 1:PO BOX 16513
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0513
Mailing Address - Country:US
Mailing Address - Phone:414-355-5594
Mailing Address - Fax:414-751-5166
Practice Address - Street 1:5600 W BROWN DEER RD
Practice Address - Street 2:SUITE 216
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2311
Practice Address - Country:US
Practice Address - Phone:414-355-5594
Practice Address - Fax:414-751-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2975251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2975OtherDEPARTMENT OF QUALITY ASSURANCE CERTIFICATION