Provider Demographics
NPI:1619945516
Name:MORSHEAD-METELICA, JEANNA M (MSE, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:JEANNA
Middle Name:M
Last Name:MORSHEAD-METELICA
Suffix:
Gender:F
Credentials:MSE, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85565 8 POINT LN
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54814-4479
Mailing Address - Country:US
Mailing Address - Phone:715-600-0346
Mailing Address - Fax:715-256-8243
Practice Address - Street 1:85565 8 POINT LN
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:WI
Practice Address - Zip Code:54814-4479
Practice Address - Country:US
Practice Address - Phone:715-600-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12128101YA0400X
WI5806-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)