Basic Information
| Provider Information | |||||||||
| NPI: | 1306327218 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLO | ||||||||
| FirstName: | BIANCA | ||||||||
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| Credential: | LPC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1138 108TH ST | ||||||||
| Address2: | |||||||||
| City: | FRANKSVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531269732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146997342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4570 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146721353 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 4241 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 1306327218 | 05 | WI | MEDICAID |