Individual
DEBRA A KOLTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,LPC,SAC,NCC
Contact information
Practice address
W10274 EDDY RD, THORP, WI 54771-7626
(715) 497-6478
Mailing address
W10274 EDDY RD, THORP, WI 54771-7626
(715) 497-6478
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15167
WI
101YM0800X
Mental Health Counselor
3438-125
WI
101YP2500X
Professional Counselor
Primary
3438-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409-78700
—
WI
01
—
93156
SECURITY HEALTH PLAN
WI
Enumeration date
11/14/2006
Last updated
04/17/2020
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