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Individual

MARA L YOUNGBAUER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPCIT

Contact information

Practice address
2600 N MAYFAIR RD, SUITE 650, WAUWATOSA, WI 53226-1309
(414) 771-9304
(414) 771-9543
Mailing address
W151N8714 MARSHALL DR, MENOMONEE FALLS, WI 53051-3109
(262) 893-3615

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1206226
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1588710073
WI
Enumeration date
05/09/2012
Last updated
05/09/2012
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