Basic Information
| Provider Information | |||||||||
| NPI: | 1942623921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MULTI-CULTURAL COUNSELING SERVICES II INC., DBA RENEW COUNSELING SERVI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 W MITCHELL ST | ||||||||
| Address2: | 223 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532043383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143834455 | ||||||||
| FaxNumber: | 4147278730 | ||||||||
| Practice Location | |||||||||
| Address1: | 6815 W CAPITOL DR | ||||||||
| Address2: | 105 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532162070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143834455 | ||||||||
| FaxNumber: | 4147278730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2014 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | CROATT | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4143834455 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 3013 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 3013 | 01 | WI | STATE LICENSE | OTHER |