Different Shades of Healing, LLC

NPI #1033772058 in Milwaukee, Wisconsin

Provider Information

NPI Number: 1033772058
Entity Type: Organization
Organization Name: Different Shades of Healing, LLC
Primary Specialty: Clinic/Center - Adolescent and Children Mental Health
Enumeration Date: Apr 16, 2019
Last Updated: Apr 16, 2019

Practice Location

Address: 6830 W VILLARD AVE STE 190
City: Milwaukee
State: Wisconsin
ZIP Code: 53218-3968
Phone: (262) 320-7886

Authorized Official

Name: NASTASSIA JACKSON, LPC-IT
Title: THERAPIST/OWNER
Phone: (414) 265-6156

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X
Clinic/Center - Adult Mental Health — Adult Mental Health	261QM0850X
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X	Primary

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