Provider Demographics
NPI:1437522893
Name:NEW LIFE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:NEW LIFE BEHAVIORAL HEALTH LLC
Other - Org Name:NEW LIFE BH LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHIATRIC / MENTAL HEALTH NP
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON-CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:414-841-8811
Mailing Address - Street 1:300 E BROADWAY
Mailing Address - Street 2:PO BOX 1924
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5057
Mailing Address - Country:US
Mailing Address - Phone:262-278-0651
Mailing Address - Fax:262-232-0866
Practice Address - Street 1:300 E BROADWAY
Practice Address - Street 2:BOX 1924
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5057
Practice Address - Country:US
Practice Address - Phone:262-278-0651
Practice Address - Fax:262-232-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1558650705Medicaid