| Wisconsin Mental Health Alliance | |
|
11414 W Park Pl Ste 202 Milwaukee WI 53224-3500 | |
| (920) 382-0071 | |
| (262) 247-0654 |
| Full Name | Wisconsin Mental Health Alliance |
|---|---|
| Speciality | Counselor |
| Location | 11414 W Park Pl Ste 202, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Gary Robert Probst (PRESIDENT) |
| Authorized Official Contact | 9203820071 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wisconsin Mental Health Alliance 744 Ridge View Dr Hartford WI 53027-2808 Ph: (192) 038-2007 | Wisconsin Mental Health Alliance 11414 W Park Pl Ste 202 Milwaukee WI 53224-3500 Ph: (920) 382-0071 |
| NPI Number | 1881455970 |
|---|---|
| Provider Enumeration Date | 01/17/2024 |
| Last Update Date | 01/17/2024 |
| Certification Date | 01/17/2024 |
| Medicare PECOS PAC ID | 3870028574 |
|---|---|
| Medicare Enrollment ID | O20241118003442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881455970 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Carmen Regina Klenner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609367853 PECOS PAC ID: 8325489446 Enrollment ID: I20240507003009 |
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