Healthcare Provider Details

I. General information

NPI: 1558736884
Provider Name (Legal Business Name): SARIS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 N ASSOCIATION DR
APPLETON WI
54914-1479
US

IV. Provider business mailing address

3416 N ASSOCIATION DR
APPLETON WI
54914-1479
US

V. Phone/Fax

Practice location:
  • Phone: 920-364-9078
  • Fax: 920-243-1792
Mailing address:
  • Phone: 920-364-9078
  • Fax: 920-243-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5873125
License Number StateWI

VIII. Authorized Official

Name: MRS. BRENDA VELISSARIS
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: MSE, LPC, NCC
Phone: 920-364-9078