Provider Demographics
NPI:1164179503
Name:HAUPT, MARY KAY (LPC, SAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:HAUPT
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6171 VALLEY PL
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9481
Mailing Address - Country:US
Mailing Address - Phone:608-386-2981
Mailing Address - Fax:
Practice Address - Street 1:2920 EAST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8231
Practice Address - Country:US
Practice Address - Phone:608-790-9481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-06
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16174-131101YA0400X
WI6553-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)