Healthcare Provider Details

I. General information

NPI: 1063507200
Provider Name (Legal Business Name): DEAN LAWRENCE HARPT LCSW, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 COUNTY ROAD B
PULASKI WI
54162-9717
US

IV. Provider business mailing address

3853 COUNTY ROAD B
PULASKI WI
54162-9717
US

V. Phone/Fax

Practice location:
  • Phone: 920-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1378-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3376-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: