Provider Demographics
NPI:1538509690
Name:LEVERENCE, MICHELLE LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LOUISE
Last Name:LEVERENCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LOUISE
Other - Last Name:FREDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7310 E RYAN RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-9358
Mailing Address - Country:US
Mailing Address - Phone:608-868-6885
Mailing Address - Fax:
Practice Address - Street 1:712 SUMMIT AVE STE 714
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3827
Practice Address - Country:US
Practice Address - Phone:262-226-2006
Practice Address - Fax:262-226-2462
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4864-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional