Provider Demographics
NPI:1063811362
Name:BERRYMAN, NATALIE R L (MS, LPC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:R L
Last Name:BERRYMAN
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5238 64TH AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3745
Mailing Address - Country:US
Mailing Address - Phone:918-388-7380
Mailing Address - Fax:
Practice Address - Street 1:6809 122ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7335
Practice Address - Country:US
Practice Address - Phone:262-891-6575
Practice Address - Fax:262-654-5467
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8296101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1063811362Medicaid