Provider Demographics
NPI:1881098028
Name:MENTAL HEALTH AMERICA OF WISCONSIN
Entity type:Organization
Organization Name:MENTAL HEALTH AMERICA OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-336-7963
Mailing Address - Street 1:600 W VIRGINIA ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-1500
Mailing Address - Country:US
Mailing Address - Phone:414-336-7963
Mailing Address - Fax:414-276-3124
Practice Address - Street 1:600 W VIRGINIA ST
Practice Address - Street 2:SUITE 502
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-1500
Practice Address - Country:US
Practice Address - Phone:414-336-7963
Practice Address - Fax:414-276-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management