Provider Demographics
NPI:1053457044
Name:CATLETT, MARCIA ANNE (LCPC, LPC, MA, MED)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ANNE
Last Name:CATLETT
Suffix:
Gender:F
Credentials:LCPC, LPC, MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-0732
Mailing Address - Country:US
Mailing Address - Phone:262-745-0368
Mailing Address - Fax:
Practice Address - Street 1:N158 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9789
Practice Address - Country:US
Practice Address - Phone:262-745-0368
Practice Address - Fax:262-745-0368
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI125-3939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI437-08-200Medicaid