Provider Demographics
NPI:1831211309
Name:ELMBROOK FAMILY COUNSELING CENTER LLP
Entity type:Organization
Organization Name:ELMBROOK FAMILY COUNSELING CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-785-9188
Mailing Address - Street 1:12690 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4636
Mailing Address - Country:US
Mailing Address - Phone:262-785-9188
Mailing Address - Fax:
Practice Address - Street 1:12690 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4636
Practice Address - Country:US
Practice Address - Phone:262-785-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1297103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty