| Crystal Lake Counseling, Llc | |
|
1821 1 1/2 Street Comstock WI 54826 | |
| (715) 822-2980 | |
| (715) 822-2205 |
| Full Name | Crystal Lake Counseling, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1821 1 1/2 Street, Comstock, Wisconsin |
| Authorized Official Name and Position | Debra Jill Severson (CLINIC OWNER AND DIRECTOR) |
| Authorized Official Contact | 7158222980 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crystal Lake Counseling, Llc 1821 1 1/2 Street P.o. Box 27 Comstock WI 54826 Ph: (715) 822-2980 | Crystal Lake Counseling, Llc 1821 1 1/2 Street Comstock WI 54826 Ph: (715) 822-2980 |
| NPI Number | 1720237373 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 09/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720237373 | NPI | - | NPPES |
| 42252900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2766 (Wisconsin) | Primary |