Doctor Name: | MRS. MELISSA CARLBERG |
NPI Number: | 1063836187 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.C. |
License Number: | 5210125 |
Business Practice Address: | 8503 75th St Ste A Kenosha, WI - 531427620 |
Business Phone Number: | 2626549370 |
Business Fax Number: | 2626549379 |
Mailing Address: | 8503 75th St Ste A, KENOSHA |
State: | WI |
Postal Code: | 531427620 |
Phone Number: | 2626549370 |
Fax Number: | 2626549379 |
NPI Enumeration Date: | 02/10/2014 |
NPI Last Update Date: | 02/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 5210125 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |