Provider Demographics
NPI:1154574549
Name:OMNI ENRICHMENT, INCORPORATION
Entity type:Organization
Organization Name:OMNI ENRICHMENT, INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CSAC,LPC-IT
Authorized Official - Phone:414-312-8910
Mailing Address - Street 1:3020 W VLIET ST
Mailing Address - Street 2:3897 N. 40TH STREET
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2461
Mailing Address - Country:US
Mailing Address - Phone:414-312-8910
Mailing Address - Fax:
Practice Address - Street 1:3020 W VLIET ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2461
Practice Address - Country:US
Practice Address - Phone:414-312-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI ENRICHMENT, INCORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42230300Medicaid