Healthcare Provider Details

I. General information

NPI: 1629617667
Provider Name (Legal Business Name): KARRIE MAY KUDRNA BEHRENT LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHOENIX BEHAVIORAL HEALTH SERVICES LLC 3120 MEMORIAL DR.
TWO RIVERS WI
54241
US

IV. Provider business mailing address

404 N MAIN ST STE 612
OSHKOSH WI
54901-4953
US

V. Phone/Fax

Practice location:
  • Phone: 920-657-1780
  • Fax: 920-657-1784
Mailing address:
  • Phone: 920-385-6009
  • Fax: 866-327-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: