Healthcare Provider Details

I. General information

NPI: 1043949761
Provider Name (Legal Business Name): AMBER LEIGH GREUEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 MIDWAY RD
MENASHA WI
54952-1115
US

IV. Provider business mailing address

1835 E EDGEWOOD DR STE 105107
APPLETON WI
54913-9407
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-2300
  • Fax:
Mailing address:
  • Phone: 920-234-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19394
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4718
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8618
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: