Individual
MS. MARA LISA PROFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., L.P.C.
Contact information
Practice address
W6905 PARKVIEW DR STE A, GREENVILLE, WI 54942-9099
(920) 540-7214
Mailing address
N1366 WOODLAND DR, GREENVILLE, WI 54942-8035
(920) 540-7214
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
736-125
WI
Other
Enumeration date
11/17/2008
Last updated
11/17/2008
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