Provider Demographics
NPI:1346593928
Name:PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP
Entity Type:Organization
Organization Name:PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP
Other - Org Name:PRO CONSULTANT GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, CSAC
Authorized Official - Phone:414-810-4431
Mailing Address - Street 1:4222 W CAPITOL DR
Mailing Address - Street 2:LOWER SUITE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4222 W CAPITOL DR
Practice Address - Street 2:LOWER SUITE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2500
Practice Address - Country:US
Practice Address - Phone:414-810-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty