Provider Demographics
NPI:1609203843
Name:CALLENDER, KARISSE ALICIA (MS, LPC, SAC)
Entity Type:Individual
Prefix:
First Name:KARISSE
Middle Name:ALICIA
Last Name:CALLENDER
Suffix:
Gender:F
Credentials:MS, LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2228
Mailing Address - Country:US
Mailing Address - Phone:715-235-4537
Mailing Address - Fax:715-235-4535
Practice Address - Street 1:320 21ST ST N
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2228
Practice Address - Country:US
Practice Address - Phone:715-235-4537
Practice Address - Fax:715-235-4535
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15765131101YA0400X
WI5125125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)