Provider Demographics
NPI:1780609636
Name:BEITZEL, LEE R (LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:R
Last Name:BEITZEL
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E MASON ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3870
Mailing Address - Country:US
Mailing Address - Phone:414-224-3737
Mailing Address - Fax:414-224-3725
Practice Address - Street 1:600 E MASON ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3870
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:414-224-3725
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1020-1231041C0700X
WI321-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39558500Medicaid