Provider Demographics
NPI:1598091928
Name:DE WITT, JOEL (LPC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:DE WITT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 101ST ST # 580302
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-9997
Mailing Address - Country:US
Mailing Address - Phone:262-320-7740
Mailing Address - Fax:
Practice Address - Street 1:4225 101ST ST UNIT 580302
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-6813
Practice Address - Country:US
Practice Address - Phone:262-320-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15673-132101YA0400X
OHC501198101YM0800X
WI4756-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health