Healthcare Provider Details

I. General information

NPI: 1700018389
Provider Name (Legal Business Name): SARIS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 ASSOCIATION DR
APPLETON WI
54914
US

IV. Provider business mailing address

3416 ASSOCIATION DR
APPLETON WI
54914
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3876125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number3876125
License Number StateWI

VIII. Authorized Official

Name: MRS. BRENDA LEE VELISSARIS
Title or Position: OWNER
Credential: LPC
Phone: 920-364-9078