Provider Demographics
NPI:1760606461
Name:SECCHI, LOURDES ANGGELINA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LOURDES
Middle Name:ANGGELINA
Last Name:SECCHI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 MAYWOOD AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-2774
Mailing Address - Country:US
Mailing Address - Phone:603-332-8962
Mailing Address - Fax:
Practice Address - Street 1:49 KESSEL CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6275
Practice Address - Country:US
Practice Address - Phone:608-280-2495
Practice Address - Fax:608-280-2428
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760606461Medicaid
WI1760606461Medicare PIN
WI1760606461Medicare UPIN
WI1760606461Medicare NSC