Provider Demographics
NPI:1497166797
Name:KETELHUT COUNSELING LLC
Entity Type:Organization
Organization Name:KETELHUT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KETELHUT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC NCC CSAC
Authorized Official - Phone:920-948-9787
Mailing Address - Street 1:1936B ALGOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2104
Mailing Address - Country:US
Mailing Address - Phone:920-948-9787
Mailing Address - Fax:920-231-1755
Practice Address - Street 1:1936B ALGOMA BLVD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2104
Practice Address - Country:US
Practice Address - Phone:920-948-9787
Practice Address - Fax:920-231-1755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4498125251S00000X
WI15724132251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health