MEDICARE: MEADOWBROOK COUNSELING OF WISCONSIN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC1900X	Counseling Psychologist
2	106H00000X	Marriage & Family Therapist
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013796572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWBROOK COUNSELING OF WISCONSIN, LLC

Provider Business Mailing Address
First Line	:	1469 N 1200 W
Second Line	:
City	:	OREM
State	:	UT
Zip	:	84057-2449
Country	:	US
Telephone Number	:	801-655-5450
Fax Number	:	385-225-9327

Provider Business Practice Location Address
First Line	:	7101 N GREEN BAY AVE STE 11
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-2800
Country	:	US
Telephone Number	:	801-655-5450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WHITNEY HEBBERT
Credential	:	LMFT
Telephone Number	:	801-655-5450

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	04/02/2026

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