CRYSTAL LAKE COUNSELING, LLC

Community/Behavioral Health

A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intellectual disabilities, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment.

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Contact Information

CRYSTAL LAKE COUNSELING, LLC

1821 1 1/2 STREET
COMSTOCK, WI 54826

Phone: 715-822-2980
Fax: 715-822-2205
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Community/Behavioral Health	251S00000X

Indicates primary specialty

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NPI Profile & details for CRYSTAL LAKE COUNSELING, LLC

NPI Number 1720237373

LBN Legal business name CRYSTAL LAKE COUNSELING, LLC

Authorized official DEBRA SEVERSON - (CLINIC OWNER AND DIRECTOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 09/18/2008

Last updated 09/18/2008 - About 18 years ago

Identifiers

WI	License #	2766
WI	Medicaid	42252900

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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