Provider Demographics
NPI:1164201638
Name:HARRISON, LENA M
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
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 3
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-0003
Mailing Address - Country:US
Mailing Address - Phone:262-207-4326
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-0003
Practice Address - Country:US
Practice Address - Phone:262-207-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4325-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional