Basic Information
| Provider Information | |||||||||
| NPI: | 1548342041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUEBBEN | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MS LPC CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 JUNIPER CT | ||||||||
| Address2: | |||||||||
| City: | WEST BEND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530954219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2623345424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10850 W PARK PL | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532243606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625423255 | ||||||||
| FaxNumber: | 4143591021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 07/01/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 042352 | WI | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 2247 | WI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 1611125 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 40966800 | 05 | WI | MEDICAID |