Provider Demographics
NPI:1639310477
Name:TREE OF LIFE CENTER
Entity Type:Organization
Organization Name:TREE OF LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:GRAMLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-510-4791
Mailing Address - Street 1:234 W FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:414-383-7050
Practice Address - Street 1:234 W FLORIDA ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1659
Practice Address - Country:US
Practice Address - Phone:414-510-4791
Practice Address - Fax:414-383-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI802-057261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health