Healthcare Provider Details

I. General information

NPI: 1598690653
Provider Name (Legal Business Name): TARA PETROZELLI-HOWE LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16655 W BLUEMOUND RD STE 301
BROOKFIELD WI
53005-5935
US

IV. Provider business mailing address

431 PARK AVE
BURLINGTON WI
53105-1128
US

V. Phone/Fax

Practice location:
  • Phone: 247-829-1254
  • Fax:
Mailing address:
  • Phone: 347-829-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8991-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: