Provider Demographics
NPI:1528208170
Name:MARQUETTE UNIVERSITY
Entity Type:Organization
Organization Name:MARQUETTE UNIVERSITY
Other - Org Name:MARQUETTE 7CS COMMUNITY COUNSELING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-288-7378
Mailing Address - Street 1:561 N. 15 STREET
Mailing Address - Street 2:ROOM 171A
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233
Mailing Address - Country:US
Mailing Address - Phone:414-288-4556
Mailing Address - Fax:414-288-6100
Practice Address - Street 1:561 N 15TH ST
Practice Address - Street 2:ROOM 171A
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2237
Practice Address - Country:US
Practice Address - Phone:414-288-4556
Practice Address - Fax:414-288-6100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health