Provider Demographics
NPI:1013563030
Name:MOUA, NHIA (APSW)
Entity Type:Individual
Prefix:
First Name:NHIA
Middle Name:
Last Name:MOUA
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W GRANDE MARKET DR STE N
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8511
Mailing Address - Country:US
Mailing Address - Phone:920-903-1060
Mailing Address - Fax:920-903-1164
Practice Address - Street 1:5601 W GRANDE MARKET DR STE N
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8511
Practice Address - Country:US
Practice Address - Phone:920-903-1060
Practice Address - Fax:920-903-1164
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI129550-121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional