Provider Demographics
NPI:1396752655
Name:MANTHEY, ELSA L (LPC)
Entity type:Individual
Prefix:MS
First Name:ELSA
Middle Name:L
Last Name:MANTHEY
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 1:1049 N LYNNDALE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3050
Mailing Address - Country:US
Mailing Address - Phone:920-731-9798
Mailing Address - Fax:920-731-1097
Practice Address - Street 1:1049 N LYNNDALE DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-3050
Practice Address - Country:US
Practice Address - Phone:920-731-9798
Practice Address - Fax:920-731-1097
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2726-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39792800Medicaid