Provider Demographics
NPI:1609242825
Name:DELISLE, TAMI JOE (MSAT, LPC-IT)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:JOE
Last Name:DELISLE
Suffix:
Gender:F
Credentials:MSAT, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:REESEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53579-0229
Mailing Address - Country:US
Mailing Address - Phone:920-382-0445
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH SPRING STREET
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:920-382-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2621-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health