Provider Demographics
NPI:1265655021
Name:COUNSELING SPECIALISTS
Entity Type:Organization
Organization Name:COUNSELING SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG-VERKUILEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:920-882-9877
Mailing Address - Street 1:W7175 FIRELANE 2
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-9401
Mailing Address - Country:US
Mailing Address - Phone:920-740-1065
Mailing Address - Fax:
Practice Address - Street 1:412 E LONGVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2168
Practice Address - Country:US
Practice Address - Phone:920-882-9877
Practice Address - Fax:920-882-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty