Provider Demographics
NPI:1437453156
Name:HARRISON, KATIE (LPC, SAC)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 W NORTH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4436
Mailing Address - Country:US
Mailing Address - Phone:262-786-9184
Mailing Address - Fax:262-786-1906
Practice Address - Street 1:17100 W NORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4436
Practice Address - Country:US
Practice Address - Phone:262-786-9184
Practice Address - Fax:262-786-1906
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4559-125101YM0800X
WI15593-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)