Individual
MARY L SEUBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
1519 3RD AVE, COLOMA, WI 54930-9406
(920) 647-6679
Mailing address
1519 3RD AVE, COLOMA, WI 54930-9406
(920) 647-6679
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1308
WI
101YP2500X
Professional Counselor
Primary
4555-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1308-132
STATE LICENSE
WI
01
—
4555-125
STATE LICENSE
WI
Enumeration date
03/01/2007
Last updated
01/08/2019
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