Provider Demographics
NPI:1720449168
Name:ELMER, ANGELINE MURIEL (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:MURIEL
Last Name:ELMER
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 1:441 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-3518
Mailing Address - Country:US
Mailing Address - Phone:608-279-3008
Mailing Address - Fax:
Practice Address - Street 1:702 N BLACKHAWK AVE STE 215
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3357
Practice Address - Country:US
Practice Address - Phone:608-233-3037
Practice Address - Fax:608-233-5893
Is Sole Proprietor?:No
Enumeration Date:2016-03-13
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7731-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional