Individual
NICHOLAS R MAYOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA LPC SAC
Contact information
Practice address
3535 30TH AVENUE, SUITE 202, KENOSHA, WI 53144
(262) 842-0500
(262) 842-0502
Mailing address
285 N JANACEK RD, BROOKFIELD, WI 53045-6102
(262) 641-9050
(262) 641-9126
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12318
WI
101YP2500X
Professional Counselor
Primary
1681-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39635400
—
WI
Enumeration date
07/28/2006
Last updated
06/20/2008
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