Provider Demographics
NPI:1952145435
Name:SORENSON, PHILIP (LPC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:SORENSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MILLINGTON LN APT 3
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1619
Mailing Address - Country:US
Mailing Address - Phone:715-370-2189
Mailing Address - Fax:
Practice Address - Street 1:100 N 72ND AVE STE 207-208
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-9042
Practice Address - Country:US
Practice Address - Phone:715-301-0267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health