Provider Demographics
NPI:1962839589
Name:SHOREVIEW COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHOREVIEW COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-301-1163
Mailing Address - Street 1:4950 N 21ST ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5750
Mailing Address - Country:US
Mailing Address - Phone:414-301-1163
Mailing Address - Fax:
Practice Address - Street 1:4950 N 21ST ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5750
Practice Address - Country:US
Practice Address - Phone:414-301-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)