Provider Demographics
NPI:1609682251
Name:MENTINK, ELIZABETH (LPC-IT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MENTINK
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6127 GREEN BAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2929
Mailing Address - Country:US
Mailing Address - Phone:262-654-8366
Mailing Address - Fax:262-842-0444
Practice Address - Street 1:6127 GREEN BAY RD STE 200
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2929
Practice Address - Country:US
Practice Address - Phone:262-654-8366
Practice Address - Fax:262-842-0444
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8225-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health