Provider Demographics
| NPI: | 1447601778 |
|---|---|
| Name: | NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY |
| Entity Type: | Organization |
| Organization Name: | NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR |
| Authorized Official - Prefix: | MISS |
| Authorized Official - First Name: | THERESA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ANTHONY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MA, CSAC, ICS |
| Authorized Official - Phone: | 262-212-4654 |
| Mailing Address - Street 1: | 2603 W ATKINSON AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MILWAUKEE |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 53209-6638 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 262-212-4654 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2603 W ATKINSON AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | MILWAUKEE |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 53209-6638 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 262-212-4654 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-06-28 |
| Last Update Date: | 2016-06-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WI | 3068 | 101YA0400X, 101YM0800X, 101YP2500X, 103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0000X, 103TP0016X, 103TP0814X, 103TP2701X, 1041C0700X, 261QM0850X, 261QR0405X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
