Healthcare Provider Details

I. General information

NPI: 1982165320
Provider Name (Legal Business Name): BRENDA L BARIBEAU LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SWEDE AVENUE
TURTLE LAKE WI
54889
US

IV. Provider business mailing address

15735 W US HIGHWAY 63
HAYWARD WI
54843-6475
US

V. Phone/Fax

Practice location:
  • Phone: 715-986-2640
  • Fax: 715-986-2521
Mailing address:
  • Phone: 888-834-4551
  • Fax: 715-598-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4772
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4772
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: