Provider Demographics
NPI:1508150327
Name:HARRENSTEIN, LISA J (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:HARRENSTEIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 S 24TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5242
Mailing Address - Country:US
Mailing Address - Phone:715-848-1457
Mailing Address - Fax:715-848-2959
Practice Address - Street 1:705 S 24TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-5242
Practice Address - Country:US
Practice Address - Phone:715-848-1457
Practice Address - Fax:715-848-2959
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4545-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1508150327Medicaid