Provider Demographics
NPI:1922718238
Name:CERISE, MILA (PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:
Last Name:CERISE
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MENDOTA ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1060
Mailing Address - Country:US
Mailing Address - Phone:604-640-4007
Mailing Address - Fax:608-640-4887
Practice Address - Street 1:1310 MENDOTA ST STE 115
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1060
Practice Address - Country:US
Practice Address - Phone:604-640-4007
Practice Address - Fax:608-640-4887
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI91222101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor