MEDICARE: KARISSA VEGA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4874-125	WI

General Provider Information

NPI Number	:	1821315789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARISSA VEGA LPC

Provider Business Mailing Address
First Line	:	1829 E JARVIS ST
Second Line	:
City	:	SHOREWOOD
State	:	WI
Zip	:	53211-2020
Country	:	US
Telephone Number	:	262-745-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 N MAYFAIR RD STE 101
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3432
Country	:	US
Telephone Number	:	414-939-5115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	08/27/2024

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Directions to “ KARISSA VEGA LPC” Practice Location

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