Individual
AMOS THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
3860 MONROE RD, DE PERE, WI 54115-8399
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10882-125
WI
101YP2500X
Professional Counselor
10882-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100197638
—
WI
Enumeration date
12/06/2021
Last updated
03/15/2024
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