Basic Information
| Provider Information | |||||||||
| NPI: | 1396395729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QAASIM | ||||||||
| FirstName: | LASHUNN | ||||||||
| MiddleName: | PATRICE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPC-IT,SAC-IT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINDOM | ||||||||
| OtherFirstName: | LASHUNN | ||||||||
| OtherMiddleName: | PATRICE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4651 N 46TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532185210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4145888759 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2814 S 108TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532273224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148853525 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 3215-226 | WI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YA0400X | 17508-130 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.