1952043259 NPI number — ELIZABETH LEE BERRY MSE, LPCIT

Table of content: ELIZABETH LEE BERRY MSE, LPCIT (NPI 1952043259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952043259 NPI number — ELIZABETH LEE BERRY MSE, LPCIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRY
Provider First Name:
ELIZABETH
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSE, LPCIT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952043259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BUILDING D02, SUITE 408 MAILBOX 4
Provider Second Line Business Mailing Address:
800 WISCONSIN STREET
Provider Business Mailing Address City Name:
EAU CLAIRE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-559-9196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUILDING D02, SUITE 408 MAILBOX 4
Provider Second Line Business Practice Location Address:
800 WISCONSIN STREET
Provider Business Practice Location Address City Name:
EAU CLAIRE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54703-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-255-0850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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