Provider Demographics
NPI:1205547619
Name:FELDHAUSEN, ELIZABETH MAE (LPCIT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MAE
Last Name:FELDHAUSEN
Suffix:
Gender:F
Credentials:LPCIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3217
Mailing Address - Country:US
Mailing Address - Phone:920-680-9368
Mailing Address - Fax:
Practice Address - Street 1:2920 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-1594
Practice Address - Country:US
Practice Address - Phone:920-632-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7141-266101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health