Provider Demographics
NPI:1396303871
Name:HARRIS, MARILYN LENSERT (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LENSERT
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 CHIPPEWA TRL
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3817
Mailing Address - Country:US
Mailing Address - Phone:608-365-6871
Mailing Address - Fax:
Practice Address - Street 1:1827 CHIPPEWA TRL
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3817
Practice Address - Country:US
Practice Address - Phone:608-365-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6894-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional