Healthcare Provider Details

I. General information

NPI: 1649760216
Provider Name (Legal Business Name): LAKES COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 ELKHORN RD STE E
LAKE GENEVA WI
53147
US

IV. Provider business mailing address

1590 ELKHORN RD STE E
LAKE GENEVA WI
53147
US

V. Phone/Fax

Practice location:
  • Phone: 262-261-1409
  • Fax:
Mailing address:
  • Phone: 262-261-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN HEPNER
Title or Position: OWNER
Credential: LCPC
Phone: 262-261-1409