Provider Demographics
NPI:1285237958
Name:DIFFERENT HORIZONS BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIFFERENT HORIZONS BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXERCUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LATIKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC, LPC-IT, ICS
Authorized Official - Phone:414-394-5517
Mailing Address - Street 1:1337 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2420
Mailing Address - Country:US
Mailing Address - Phone:414-394-5517
Mailing Address - Fax:
Practice Address - Street 1:1337 N 30TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2420
Practice Address - Country:US
Practice Address - Phone:414-394-5517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty