Provider Demographics
NPI:1740943695
Name:DESAI-WALTER, HARSHITA (LPC)
Entity type:Individual
Prefix:
First Name:HARSHITA
Middle Name:
Last Name:DESAI-WALTER
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 1:200 DAIRY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2680
Mailing Address - Country:US
Mailing Address - Phone:262-312-8509
Mailing Address - Fax:
Practice Address - Street 1:1215 GEORGE TOWNE DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2731
Practice Address - Country:US
Practice Address - Phone:414-266-3339
Practice Address - Fax:262-691-4287
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8983125101YP2500X
WI7983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1740943695Medicaid