Provider Demographics
NPI:1972770113
Name:ACTS OUTREACH MINISTRIES, INC.
Entity Type:Organization
Organization Name:ACTS OUTREACH MINISTRIES, INC.
Other - Org Name:ASSOCIATED COUNSELING & TRAINING SERVICES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CADC III, BA
Authorized Official - Phone:414-393-1070
Mailing Address - Street 1:6815 W CAPITOL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2070
Mailing Address - Country:US
Mailing Address - Phone:414-393-1070
Mailing Address - Fax:414-393-1072
Practice Address - Street 1:6815 W CAPITOL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2070
Practice Address - Country:US
Practice Address - Phone:414-393-1070
Practice Address - Fax:414-393-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2320251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42223121Medicaid
WI41161200Medicaid
WI42223100Medicaid