Basic Information
| Provider Information | |||||||||
| NPI: | 1831234012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COPE BEHAVIORAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 N 4TH ST | ||||||||
| Address2: | SUITE # 121 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532122362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142655112 | ||||||||
| FaxNumber: | 4142654140 | ||||||||
| Practice Location | |||||||||
| Address1: | 2821 N 4TH ST | ||||||||
| Address2: | SUITE # 121 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532122362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4142655112 | ||||||||
| FaxNumber: | 4142654140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUYTON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4142655087 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2587 | WI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 42240800 | 05 | WI | MEDICAID | 40997400 | 05 | WI | MEDICAID |