Provider Demographics
NPI:1316381510
Name:MEYER, KIRSTIN E (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:E
Last Name:MEYER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:E
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:1201 W BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5116
Mailing Address - Country:US
Mailing Address - Phone:414-333-1379
Mailing Address - Fax:
Practice Address - Street 1:11649 N PORT WASHINGTON RD STE 201
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3459
Practice Address - Country:US
Practice Address - Phone:262-789-1191
Practice Address - Fax:262-478-0030
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1205-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional