Individual
FRED JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADCIII, LPC
Contact information
Practice address
5303 W NORTH AVE, MILWAUKEE, WI 53208
(414) 445-0997
(414) 445-0989
Mailing address
5303 W NORTH AVE, MILWAUKEE, WI 53208-1021
(414) 445-0997
(414) 445-0989
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
151
WI
101YP2500X
Professional Counselor
Primary
3220-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151
CADCIII
WI
01
—
3220-125
LPC
WI
05
—
39736200
—
WI
Enumeration date
10/17/2006
Last updated
08/03/2018
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