Individual
ROGER MACK PUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
6040 W LISBON AVE, SUITE 102, MILWAUKEE, WI 53210-2116
(414) 871-9111
(414) 871-9121
Mailing address
7481 N NAVAJO RD, FOX POINT, WI 53217-3463
(414) 228-6419
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1328-125
WI
101YP2500X
Professional Counselor
1157-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39668000
—
WI
Enumeration date
07/24/2007
Last updated
07/24/2007
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