Healthcare Provider Details

I. General information

NPI: 1104670918
Provider Name (Legal Business Name): ENSO COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BOWLING LN
WAUPACA WI
54981-7707
US

IV. Provider business mailing address

604 E LAKE ST
WAUPACA WI
54981-1849
US

V. Phone/Fax

Practice location:
  • Phone: 715-201-2758
  • Fax: 715-204-7151
Mailing address:
  • Phone: 608-228-9552
  • Fax: 715-204-7151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELISSA LEONORA STULTS
Title or Position: OWNER
Credential: LMFT
Phone: 715-201-2758