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Organization
KRISTA SHABTAIE LCSW
Active
Organization
KRISTA SHABTAIE LCSW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA SHABTAIE LCSW (SOCIAL WORKER -- OWNER)
(413) 478-8760
Entity
Organization
Contact information
Practice address
933 N MAYFAIR RD STE 101, MILWAUKEE, WI 53226-3432
(413) 478-8760
(414) 249-5443
Mailing address
933 N MAYFAIR RD STE 101, MILWAUKEE, WI 53226-3432
(413) 478-8760
(414) 249-5443
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013482587
—
WI
Enumeration date
09/09/2020
Last updated
09/09/2020
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