Provider Demographics
NPI:1013163831
Name:TORRES, JOANNE MARIE (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:TORRES
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:TORRES-JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSAC
Mailing Address - Street 1:1570 MIDWAY PL
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1165
Mailing Address - Country:US
Mailing Address - Phone:920-720-1464
Mailing Address - Fax:
Practice Address - Street 1:2640 WEST POINT ROAD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304
Practice Address - Country:US
Practice Address - Phone:920-490-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11732-132101YA0400X
WI7588-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39167200Medicaid