Provider Demographics
NPI:1780191973
Name:MAUK, KRISTINA M (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:MAUK
Suffix:
Gender:F
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:LECHNIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:EDGAR
Mailing Address - State:WI
Mailing Address - Zip Code:54426-9266
Mailing Address - Country:US
Mailing Address - Phone:715-297-3827
Mailing Address - Fax:844-927-0227
Practice Address - Street 1:500 N 3RD ST STE 220
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4857
Practice Address - Country:US
Practice Address - Phone:715-575-1421
Practice Address - Fax:844-927-0227
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18261101YA0400X
WI7566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)