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General NPI Number Information
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NPI Number | 1144325168
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Entity Type | Organization
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Legal Business Name | WAUKESHA COUNSELING SERVICES
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 2717 N GRANDVIEW BLVD SUITE 111
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 262-544-4540
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 N GRANDVIEW BLVD SUITE 111
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 262-544-4540
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURI FLICK-HARTY
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Credential |
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Telephone | 262-544-4540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1001-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7175-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 681-124
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1254-125
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License Number State | WI
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