Provider Demographics
NPI:1982947602
Name:VALLEY COUNSELING & CLINICAL PSYCHOLOGY
Entity Type:Organization
Organization Name:VALLEY COUNSELING & CLINICAL PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSLOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:KJOLSING
Authorized Official - Last Name:SATHER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:715-781-8970
Mailing Address - Street 1:1810 CREST VIEW DR
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-9494
Mailing Address - Country:US
Mailing Address - Phone:715-781-8970
Mailing Address - Fax:715-377-0010
Practice Address - Street 1:1810 CREST VIEW DR
Practice Address - Street 2:SUITE 2D
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9494
Practice Address - Country:US
Practice Address - Phone:715-781-8970
Practice Address - Fax:715-377-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4971-125101YP2500X
WI5021-125101YP2500X
WI4899-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1205130101Medicaid
WI1851643332Medicaid
WI1154665735Medicaid