Individual
MARA TIBBALS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10150 W NATIONAL AVE STE 390, WEST ALLIS, WI 53227-2145
(414) 545-4430
Mailing address
W142N8220 MERRIMAC DR, MENOMONEE FALLS, WI 53051-3947
(262) 853-4488
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
7480-226
WI
Other
Enumeration date
08/23/2023
Last updated
08/23/2023
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