Provider Demographics
NPI:1649760216
Name:LAKES COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:LAKES COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:HEPNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:262-261-1409
Mailing Address - Street 1:N3219 COUNTY TRUNK H STE E
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-7074
Mailing Address - Country:US
Mailing Address - Phone:262-261-1409
Mailing Address - Fax:
Practice Address - Street 1:N3219 COUNTY H STE E
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-7074
Practice Address - Country:US
Practice Address - Phone:262-261-1409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI6913-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty