Provider Demographics
NPI:1386847168
Name:WENDELL J. HARRIS & ASSOCIATES LLC
Entity Type:Organization
Organization Name:WENDELL J. HARRIS & ASSOCIATES LLC
Other - Org Name:REUBEN HARRIS INSTITUET FOR FAMILE ENRICHMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:M S-CADC-1
Authorized Official - Phone:414-265-5538
Mailing Address - Street 1:2821 N 4TH ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2362
Mailing Address - Country:US
Mailing Address - Phone:414-265-5538
Mailing Address - Fax:414-265-4533
Practice Address - Street 1:2821 N 4TH ST
Practice Address - Street 2:SUITE 224
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2362
Practice Address - Country:US
Practice Address - Phone:414-265-5538
Practice Address - Fax:414-265-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42247021Medicaid
WI42247000Medicaid