Healthcare Provider Details

I. General information

NPI: 1164201638
Provider Name (Legal Business Name): LENA M HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

2163 US HIGHWAY 8 SUITE 100 UNIT #8077
ST CROIX FALLS WI
54024-4424
US

V. Phone/Fax

Practice location:
  • Phone: 262-207-4326
  • Fax:
Mailing address:
  • Phone: 262-207-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4325-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: