Provider Demographics
NPI:1558022970
Name:COLLECTIVE COUNSELING AND CONSULTATION, LLC
Entity Type:Organization
Organization Name:COLLECTIVE COUNSELING AND CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:414-367-9155
Mailing Address - Street 1:11801 W SILVER SPRING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3092
Mailing Address - Country:US
Mailing Address - Phone:414-367-9155
Mailing Address - Fax:
Practice Address - Street 1:11801 W SILVER SPRING DR STE 107
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3092
Practice Address - Country:US
Practice Address - Phone:414-367-9155
Practice Address - Fax:414-600-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)