Provider Demographics
NPI:1902011109
Name:WUNDERLICH, DENISE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:WUNDERLICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-0475
Mailing Address - Country:US
Mailing Address - Phone:248-217-2353
Mailing Address - Fax:
Practice Address - Street 1:2150 W. SOUTH AIRPORT RD, SUITE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1387
Practice Address - Country:US
Practice Address - Phone:248-217-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000759101YP2500X, 101Y00000X
MI68010587361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical