Provider Demographics
NPI:1346579653
Name:MINDSTAR COUNSELING, LLC.
Entity Type:Organization
Organization Name:MINDSTAR COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STARLETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-435-1115
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-1115
Mailing Address - Country:US
Mailing Address - Phone:414-435-1115
Mailing Address - Fax:414-435-0543
Practice Address - Street 1:4025 N 92ND ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-1613
Practice Address - Country:US
Practice Address - Phone:414-435-1115
Practice Address - Fax:414-435-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1346579653Medicaid