Provider Demographics
NPI:1407593619
Name:MERAKI THERAPY & WELLNESS, LLC
Entity Type:Organization
Organization Name:MERAKI THERAPY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAACK
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LPC, CSAC
Authorized Official - Phone:920-288-2846
Mailing Address - Street 1:1270 MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1337
Mailing Address - Country:US
Mailing Address - Phone:920-288-2846
Mailing Address - Fax:920-770-4153
Practice Address - Street 1:1270 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1337
Practice Address - Country:US
Practice Address - Phone:920-378-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100095134Medicaid
WI1336784545Medicaid