Provider Demographics
NPI:1194286294
Name:1-9 YOUTH & FAMILY SERVICES
Entity type:Organization
Organization Name:1-9 YOUTH & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:REE
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-630-4986
Mailing Address - Street 1:3603 N HUMBOLDT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1705
Mailing Address - Country:US
Mailing Address - Phone:414-630-4986
Mailing Address - Fax:
Practice Address - Street 1:2201 N MLK DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3125
Practice Address - Country:US
Practice Address - Phone:414-630-4986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1-9 YOUTH & FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty