Provider Demographics
NPI:1881455970
Name:WISCONSIN MENTAL HEALTH ALLIANCE
Entity type:Organization
Organization Name:WISCONSIN MENTAL HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PROBST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:920-382-0071
Mailing Address - Street 1:744 RIDGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53027-2808
Mailing Address - Country:US
Mailing Address - Phone:192-038-2007
Mailing Address - Fax:262-234-7065
Practice Address - Street 1:11414 W PARK PL STE 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3500
Practice Address - Country:US
Practice Address - Phone:920-382-0071
Practice Address - Fax:262-247-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty