Organization
CRYSTAL LAKE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBRA JILL SEVERSON MS LPC (CLINIC OWNER AND DIRECTOR)
(715) 822-2980
Entity
Organization
Contact information
Practice address
1821 1 1/2 STREET, COMSTOCK, WI 54826
(715) 822-2980
(715) 822-2205
Mailing address
1821 1 1/2 STREET, P.O. BOX 27, COMSTOCK, WI 54826
(715) 822-2980
(715) 822-2205
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2766
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42252900
—
WI
Enumeration date
09/18/2008
Last updated
09/18/2008
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