Provider Demographics
NPI:1528586138
Name:ALICE MACKEY LLC
Entity Type:Organization
Organization Name:ALICE MACKEY LLC
Other - Org Name:AM COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-409-3546
Mailing Address - Street 1:2354 N 59TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210
Mailing Address - Country:US
Mailing Address - Phone:207-522-1219
Mailing Address - Fax:
Practice Address - Street 1:1126 S 70TH ST SUITE 121
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:414-409-3546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-04
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39732700Medicaid