Provider Demographics
NPI:1720497308
Name:NEW BEGINNINGS MENTAL HEALTH CLINIC LLC.
Entity type:Organization
Organization Name:NEW BEGINNINGS MENTAL HEALTH CLINIC LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-329-4673
Mailing Address - Street 1:6754 W BELOIT RD
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-2068
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6754 W BELOIT RD
Practice Address - Street 2:STE 10
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-2068
Practice Address - Country:US
Practice Address - Phone:414-329-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3048261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3048Medicaid