Provider Demographics
NPI:1295715472
Name:NORTH STAR COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:NORTH STAR COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOOK-WOOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-257-0500
Mailing Address - Street 1:W175N11163 STONEWOOD DR.
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6503
Mailing Address - Country:US
Mailing Address - Phone:262-257-0500
Mailing Address - Fax:
Practice Address - Street 1:W175N11163 STONEWOOD DR.
Practice Address - Street 2:SUITE 225
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6503
Practice Address - Country:US
Practice Address - Phone:262-257-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-22
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2451-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43568200Medicaid