| Stacey King, LPC IT | |
|
3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209-1220 | |
| (414) 540-2170 | |
| Not Available |
| Full Name | Stacey King |
|---|---|
| Gender | Female |
| Speciality | Mental Health Counselor |
| Experience | 4 Years |
| Location | 3900 W Brown Deer Rd Ste 200, Brown Deer, Wisconsin |
| Accepts Medicare Assignments | May be. She may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649733189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 18842-130 (Wisconsin) | Secondary |
| 101YP2500X | Counselor - Professional | 11960-125 (Wisconsin) | Primary |
| Entity Name | Sondermind Provider Network LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20241224001550 |
| Mailing Address | Practice Location Address |
|---|---|
| Stacey King, LPC IT 611a N 62nd St, Wauwatosa, WI 53213-4171 Ph: (414) 346-6423 | Stacey King, LPC IT 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209-1220 Ph: (414) 540-2170 |
Zoe Faivre Werth, M.S. Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 |
Virginia G Livingston, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 7646 N Teutonia Ave, Brown Deer, WI 53209 Phone: 414-979-2155 |
Jenna Mohelnitzky, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209 Phone: 414-540-2170 |
Je'sean Scott, Counselor Medicare: Not Enrolled in Medicare Practice Location: 5600 W Brown Deer Rd Ste 106, Brown Deer, WI 53223 Phone: 414-446-8154 |
Anastacia Clucas, Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd Ste 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 |
Ms. Wendy Ann Diehls, APSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 |
Ms. Kristin Ann Johnson, MS LPC Counselor Medicare: Accepting Medicare Assignments Practice Location: 3900 W Brown Deer Rd, Suite 200, Brown Deer, WI 53209 Phone: 414-540-2170 Fax: 414-540-2171 |