Provider Demographics
NPI:1043527799
Name:STULTS, ELISSA L (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:L
Last Name:STULTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ELISSA
Other - Middle Name:LEONORA
Other - Last Name:ACHTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:750 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-7707
Mailing Address - Country:US
Mailing Address - Phone:715-201-2758
Mailing Address - Fax:715-204-7151
Practice Address - Street 1:201 S MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-1564
Practice Address - Country:US
Practice Address - Phone:715-345-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI844-124106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist