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Organization
PROFESSIONAL SERVICES GROUP, INC.
Active
Organization
PROFESSIONAL SERVICES GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN A. WOLF PHD. (CLINICAL DIRECTOR)
(262) 652-2406
Entity
Organization
Contact information
Practice address
1126 S 70TH ST, SUITE S507, WEST ALLIS, WI 53214-3151
(414) 727-2789
(414) 476-8695
Mailing address
6233 39TH AVE, KENOSHA, WI 53142-7015
(262) 654-1004
(262) 654-6960
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
2365
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42235000
—
WI
Enumeration date
10/27/2006
Last updated
06/30/2008
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