| Organization Name: | CRYSTAL LAKE COUNSELING, LLC |
| NPI Number: | 1720237373 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DEBRA JILL SEVERSON (CLINIC OWNER AND DIRECTOR) |
| Mailing Address: | 1821 1 1/2 Street Comstock |
| State: | WI US |
| Postal Code: | 54826 |
| Phone Number: | 7158222980 |
| Fax Number: | 7158222205 |
| NPI Enumeration Date: | 09/18/2008 |
| NPI Last Update Date: | 09/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251S00000X |
| License Number: | 2766 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Community/Behavioral Health |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |