Provider Demographics
NPI:1639672108
Name:HALCYON WELLNESS LLC
Entity Type:Organization
Organization Name:HALCYON WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:715-861-7762
Mailing Address - Street 1:4905 157TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-9004
Mailing Address - Country:US
Mailing Address - Phone:715-723-4130
Mailing Address - Fax:715-723-4130
Practice Address - Street 1:345 FRENETTE DR STE 4
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3072
Practice Address - Country:US
Practice Address - Phone:715-861-7762
Practice Address - Fax:715-861-7762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-12
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4017-125261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)