Healthcare Provider Details

I. General information

NPI: 1447644562
Provider Name (Legal Business Name): YURK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 04/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W4711 CASTLE DRIVE
SHERWOOD WI
54169-9661
US

IV. Provider business mailing address

W4711 CASTLE DRIVE
SHERWOOD WI
54169-9661
US

V. Phone/Fax

Practice location:
  • Phone: 920-287-0406
  • Fax: 920-287-0410
Mailing address:
  • Phone: 920-287-0406
  • Fax: 920-287-0410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3000-125
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TINA GRAY-SIEBERS
Title or Position: LICENSED PROFESSIONAL COUNSELOR OWN
Credential: LPC, CCATP
Phone: 920-287-0406