Individual
MR. JACOB M MECCA-GUILLIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT, LPC
Contact information
Practice address
400 BAY VIEW RD STE C, MUKWONAGO, WI 53149-1770
(622) 789-1191
Mailing address
400 BAY VIEW RD STE C, MUKWONAGO, WI 53149-1770
(622) 789-1191
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
4208-226
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
18715-130
WI
101YP2500X
Professional Counselor
Primary
8241-125
WI
Other
Enumeration date
11/08/2018
Last updated
04/19/2022
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