Provider Demographics
NPI:1881220408
Name:PETRELLI-HOLST, DENISE (LPC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:PETRELLI-HOLST
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 1ST ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-9649
Mailing Address - Country:US
Mailing Address - Phone:262-498-6049
Mailing Address - Fax:
Practice Address - Street 1:2515 1ST ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-9649
Practice Address - Country:US
Practice Address - Phone:262-498-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7028-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional