Provider Demographics
NPI:1750729984
Name:FOOTSTEPS COUNSELING
Entity type:Organization
Organization Name:FOOTSTEPS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:414-491-2140
Mailing Address - Street 1:11803 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2077
Mailing Address - Country:US
Mailing Address - Phone:414-491-2140
Mailing Address - Fax:414-258-1337
Practice Address - Street 1:11803 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2077
Practice Address - Country:US
Practice Address - Phone:414-491-2140
Practice Address - Fax:414-258-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7889-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty