Glen Haven Counseling Clinic

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

1384 Issued in WI

Legal business name

GLEN HAVEN COUNSELING CLINIC

Practice address

6270 N Port Washington Rd
Suite 201
Glendale, WI 53217-4311

Phone

(414) 962-2284

NPI assigned

May 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerrold Bernard Rousseau, MSSW, LCSWNPI 1992915177

Title

Owner

Phone

(414) 962-2284

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerrold Bernard Rousseau, MSSW, LCSW

  • Clinical Social Worker
  • Glendale, WI
  • NPI 1992915177
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285844480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6270 N PORT WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174311",
            "telephone_number": "414-962-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6270 N PORT WASHINGTON RD",
            "address_2": "SUITE 201",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174311",
            "telephone_number": "414-962-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN HAVEN COUNSELING CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROUSSEAU",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_middle_name": "BERNARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-962-2284",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "1384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan R Gerondale, D.C.
• Gretchen J. Gill, PH.D.
• Michael H Gilman, D.O.
• Alyssa Gilster, APSW
• Gaelyn R Gingery
• Glendale Anesthesia Associates
• Glendale Care and Rehab Center LLC
• Glendale Dental LLC
• Glendale Optimal Dental Care, Inc.
• Glendale Prescription Center Inc

• Community/Behavioral Health Agency in Glendale, WI
• Providers in Glendale, WI by specialty
• Community/Behavioral Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.