Basic Information
| Provider Information | |||||||||
| NPI: | 1366063521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETRAUSKAS | ||||||||
| FirstName: | HOLLY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC, CSAC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4570 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4146721353 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4570 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306187775 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2020 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6891-125 | WI | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | 16379-132 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.