Provider Demographics
NPI:1275076341
Name:REMITZ, BETH J I (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:J
Last Name:REMITZ
Suffix:I
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:J
Other - Last Name:REMITZ
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-0634
Mailing Address - Country:US
Mailing Address - Phone:262-227-1684
Mailing Address - Fax:
Practice Address - Street 1:13105 W BLUEMOUND RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-8022
Practice Address - Country:US
Practice Address - Phone:262-641-9790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3487-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000084958Medicare Oscar/Certification