Healthcare Provider Details

I. General information

NPI: 1669733937
Provider Name (Legal Business Name): HARUCHA TAMLICHA ALY-GREENWOLD MS, MA,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 CRESCENT AVE
EAU CLAIRE WI
54703-6093
US

IV. Provider business mailing address

2607 CRESCENT AVE
EAU CLAIRE WI
54703-6093
US

V. Phone/Fax

Practice location:
  • Phone: 715-210-7760
  • Fax:
Mailing address:
  • Phone: 715-210-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12600-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: