Acacia Clinic, Inc.

LBN: Acacia Clinic, Inc.
Acacia Clinic, Inc. is an health care organization with primary practice located at 6040 W Lisbon Ave Suite 102, Milwaukee WI 53210-2116. The organization recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Counseling. Behavioral Health & Social Service Providers / Mental Health is the primary health care specialty. Acacia Clinic, Inc. can be contacted via phone (414) 871-9111, or through Kozlowski, Deidra Lee via phone (414) 871-9111.

Contact Information

Primary practice address
6040 W Lisbon Ave Suite 102 Milwaukee WI 53210-2116
Phone: (414) 871-9111
Fax: (414) 871-9121
Website:
Map and Directions
Authorized official contact:
Name: Kozlowski, Deidra Lee
Phone: (414) 871-9111

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 1066 Wisconsin
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1066 Wisconsin
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1066 Wisconsin
Behavioral Health & Social Service Providers / Counseling 103TC1900X 1066 Wisconsin
Behavioral Health & Social Service Providers / Clinical 1041C0700X 1066 Wisconsin

Profile Details

NPI number 1417988973
LBN Legal business name Acacia Clinic, Inc.
DBA Doing business as
Authorized official Kozlowski, Deidra Lee
Entity Organization
Organization subpart 1 No
Enumeration date Jul 5th, 2006
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417988973 NPPES
Wisconsin MEDICAID 42167800

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