Healthcare Provider Details

I. General information

NPI: 1376482497
Provider Name (Legal Business Name): NORTHERN LIGHTS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 W COLLEGE AVE STE 200
APPLETON WI
54914-3968
US

IV. Provider business mailing address

W2306 KHLOE LN
FREEDOM WI
54913-2726
US

V. Phone/Fax

Practice location:
  • Phone: 920-215-1645
  • Fax:
Mailing address:
  • Phone: 920-215-1645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: EMILY M HOCH
Title or Position: OWNER, MENTAL HEALTH THERAPIST
Credential: MSW, CAPSW, CSAC
Phone: 920-215-1645