Basic Information
| Provider Information | |||||||||
| NPI: | 1801228705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ECHEVARRIA | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | RAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC-IT; SAC-IT, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 MILLER PARK WAY | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532143604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146723801 | ||||||||
| FaxNumber: | 4146726026 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 S 114TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532271031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144494444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2013 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 18785-130 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 4110-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.