Provider Demographics
NPI:1780696799
Name:GUSE, TERESA MARIE (LPC, NBCC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:GUSE
Suffix:
Gender:F
Credentials:LPC, NBCC
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3365 S 103RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-4161
Mailing Address - Country:US
Mailing Address - Phone:142-284-8004
Mailing Address - Fax:262-432-9004
Practice Address - Street 1:3365 S 103RD ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4161
Practice Address - Country:US
Practice Address - Phone:414-228-4800
Practice Address - Fax:262-432-9004
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3636-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1780696799Medicaid