Provider Demographics
NPI:1073148656
Name:PAULI, MARY T (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:PAULI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W GRAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6273
Mailing Address - Country:US
Mailing Address - Phone:608-346-8315
Mailing Address - Fax:
Practice Address - Street 1:136 W GRAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6273
Practice Address - Country:US
Practice Address - Phone:608-346-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010034101YM0800X
WI7545-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health