Provider Demographics
NPI:1649903386
Name:LAURITZEN, NICOLE R (LPC-T)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:LAURITZEN
Suffix:
Gender:F
Credentials:LPC-T
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2012
Mailing Address - Country:US
Mailing Address - Phone:715-258-6388
Mailing Address - Fax:715-258-6409
Practice Address - Street 1:811 HARDING ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2012
Practice Address - Country:US
Practice Address - Phone:715-258-6388
Practice Address - Fax:715-258-6409
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3974-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional