Provider Demographics
NPI:1982165320
Name:BARIBEAU, BRENDA L (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BARIBEAU
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 1:15735 W US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6475
Mailing Address - Country:US
Mailing Address - Phone:888-834-4551
Mailing Address - Fax:715-598-4881
Practice Address - Street 1:730 SWEDE AVENUE
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54889
Practice Address - Country:US
Practice Address - Phone:715-986-2640
Practice Address - Fax:715-986-2521
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4772101YM0800X, 101YP2500X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11345OtherSTATE LICENSE - LPC
WI4772-226OtherLPC-IT
WI18832-130OtherSAC-IT