Individual
DAVID TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
631 FOREST ST, WAUSAU, WI 54403-5524
(715) 842-0944
(715) 845-6477
Mailing address
631 FOREST ST, WAUSAU, WI 54403-5524
(715) 842-0944
(715) 845-6477
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5350-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649686973
—
WI
Enumeration date
07/08/2014
Last updated
09/09/2014
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