Provider Demographics
NPI:1821315789
Name:VEGA, KARISSA (LPC)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:VEGA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:
Other - Last Name:KESSELHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1829 E JARVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2020
Mailing Address - Country:US
Mailing Address - Phone:262-745-1942
Mailing Address - Fax:
Practice Address - Street 1:933 N MAYFAIR RD STE 101
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3432
Practice Address - Country:US
Practice Address - Phone:414-939-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4874-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional