Healthcare Provider Details

I. General information

NPI: 1992920300
Provider Name (Legal Business Name): PSYCHOLOGICAL CONSULATNTS S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E. WALUNT STREET 604
GREEN BAY WI
54301
US

IV. Provider business mailing address

130 E. WALUNT STREET 604
GREEN BAY WI
54301
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-3854
  • Fax: 920-437-7488
Mailing address:
  • Phone: 920-437-3854
  • Fax: 920-437-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2463-057
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1042
License Number StateWI

VIII. Authorized Official

Name: DR. URSULA BERTRAND
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 920-437-3854