Provider Demographics
NPI:1346582079
Name:METZLER, AMANDA J (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:METZLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1418 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9578
Mailing Address - Country:US
Mailing Address - Phone:920-410-9373
Mailing Address - Fax:920-247-2276
Practice Address - Street 1:3311 PACKERLAND DR STE A
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9539
Practice Address - Country:US
Practice Address - Phone:920-410-9373
Practice Address - Fax:920-247-2276
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4983-125101YP2500X
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100028818Medicaid