Individual
DEBRA DEDERICH-ELSNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
2112 MAIN ST NE, LOS LUNAS, NM 87031-7097
(505) 717-1155
(505) 717-1473
Mailing address
1499 6TH ST, GREEN BAY, WI 54304-2252
(920) 497-6161
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2316-226
WI
101YP2500X
Professional Counselor
Primary
CCMH0206261
NM
Other
Enumeration date
10/01/2015
Last updated
09/27/2019
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