Provider Demographics
NPI:1396221636
Name:DELIS, CANDACE R (LPC, LPCC, LMHC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:R
Last Name:DELIS
Suffix:
Gender:F
Credentials:LPC, LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4018 HENKE RD
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-9253
Mailing Address - Country:US
Mailing Address - Phone:715-697-4928
Mailing Address - Fax:
Practice Address - Street 1:4018 HENKE RD
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-9253
Practice Address - Country:US
Practice Address - Phone:715-697-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61485659101YM0800X
IA110339101YM0800X
CA13647101YP2500X
WI8026-125101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty