Provider Demographics
NPI:1033259676
Name:DESSEL, B. HAL (LCSW, CADC III)
Entity Type:Individual
Prefix:MR
First Name:B.
Middle Name:HAL
Last Name:DESSEL
Suffix:
Gender:M
Credentials:LCSW, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6513
Mailing Address - Country:US
Mailing Address - Phone:414-221-9293
Mailing Address - Fax:414-221-9532
Practice Address - Street 1:921 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-6513
Practice Address - Country:US
Practice Address - Phone:414-221-9293
Practice Address - Fax:414-221-9532
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1584-132101YA0400X
WI1773-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39280200Medicaid