Provider Demographics
NPI:1649404039
Name:GROESCHEL, BRIAN LEE (LPC, CSAC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:LEE
Last Name:GROESCHEL
Suffix:
Gender:M
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2301
Mailing Address - Country:US
Mailing Address - Phone:414-643-8530
Mailing Address - Fax:414-647-8602
Practice Address - Street 1:1111 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2301
Practice Address - Country:US
Practice Address - Phone:414-643-8530
Practice Address - Fax:414-647-8602
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15461-132101YA0400X
WI4566-125101YP2500X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional