Individual
MR. BENJAMIN MICHAEL BLECK-OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCIT SACIT
Contact information
Practice address
5508 W. VLIET STREET, MILWAUKEE, WI 53208
(414) 476-1073
(414) 476-0223
Mailing address
5508 W. VLIET STREET, MILWAUKEE, WI 53208
(414) 476-1073
(414) 476-0223
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
17353-130
WI
101YM0800X
Mental Health Counselor
2718-226
WI
Other
Enumeration date
11/18/2016
Last updated
11/18/2016
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