Provider Demographics
NPI:1861840233
Name:ASSURED CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:ASSURED CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:414-810-2715
Mailing Address - Street 1:PO BOX 14781
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-0781
Mailing Address - Country:US
Mailing Address - Phone:414-810-2715
Mailing Address - Fax:
Practice Address - Street 1:1845 N FARWELL AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1793
Practice Address - Country:US
Practice Address - Phone:414-810-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8053251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health