Healthcare Provider Details

I. General information

NPI: 1649356882
Provider Name (Legal Business Name): KRISTIN LAUREL METOXEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

IV. Provider business mailing address

8215 GREENWAY BLVD STE 160
MIDDLETON WI
53562-3689
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax:
Mailing address:
  • Phone: 920-366-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3848-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: