Provider Demographics
NPI:1821248048
Name:ALLIED MENTAL HEALTH REHABILITATION CLINICS
Entity Type:Organization
Organization Name:ALLIED MENTAL HEALTH REHABILITATION CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-255-4178
Mailing Address - Street 1:N84 W19587 MENOMONEE AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1826
Mailing Address - Country:US
Mailing Address - Phone:262-255-4178
Mailing Address - Fax:262-255-4448
Practice Address - Street 1:N84 W19587 MENOMONEE AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-1826
Practice Address - Country:US
Practice Address - Phone:262-255-4178
Practice Address - Fax:262-255-4448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES L PAQUETTE PHD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1031261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42148100Medicaid