Provider Demographics
NPI:1063836187
Name:CARLBERG, MELISSA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:CARLBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 73RD ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5240
Mailing Address - Country:US
Mailing Address - Phone:262-592-8854
Mailing Address - Fax:262-208-1765
Practice Address - Street 1:2612 73RD ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5240
Practice Address - Country:US
Practice Address - Phone:262-592-8854
Practice Address - Fax:262-208-1765
Is Sole Proprietor?:No
Enumeration Date:2014-02-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5210125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional