Provider Demographics
NPI:1033643366
Name:NELSON, KARISSA J (MS, LPC IT)
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS, LPC IT
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:J
Other - Last Name:TESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474-1614
Mailing Address - Country:US
Mailing Address - Phone:715-551-3084
Mailing Address - Fax:715-298-6365
Practice Address - Street 1:3704 WESTON AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5242
Practice Address - Country:US
Practice Address - Phone:715-298-6364
Practice Address - Fax:715-298-6365
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3490-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health