Provider Demographics
NPI:1780945741
Name:TIELENS, CAITLYN QUINN (LPC)
Entity type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:QUINN
Last Name:TIELENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CAITLYN
Other - Middle Name:MARIE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:N5367 MAYFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:SHIOCTON
Mailing Address - State:WI
Mailing Address - Zip Code:54170-8934
Mailing Address - Country:US
Mailing Address - Phone:920-986-3003
Mailing Address - Fax:920-986-3004
Practice Address - Street 1:N5367 MAYFLOWER RD
Practice Address - Street 2:
Practice Address - City:SHIOCTON
Practice Address - State:WI
Practice Address - Zip Code:54170-8934
Practice Address - Country:US
Practice Address - Phone:920-986-3003
Practice Address - Fax:920-986-3004
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012007105101YM0800X
WI5432-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health