Organization
GLEN HAVEN COUNSELING CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERROLD BERNARD ROUSSEAU MSSW, LCSW (OWNER)
(414) 962-2284
Entity
Organization
Contact information
Practice address
6270 N PORT WASHINGTON RD, SUITE 201, GLENDALE, WI 53217-4311
(414) 962-2284
Mailing address
6270 N PORT WASHINGTON RD, SUITE 201, GLENDALE, WI 53217-4311
(414) 962-2284
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1384
WI
Other
Enumeration date
05/23/2007
Last updated
08/22/2020
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