Provider Demographics
NPI:1164804274
Name:NIMPHIUS, MARY-CATHERINE
Entity Type:Individual
Prefix:
First Name:MARY-CATHERINE
Middle Name:
Last Name:NIMPHIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S. SUNNY SLOPE RD
Mailing Address - Street 2:#128
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-782-2820
Mailing Address - Fax:262-782-6937
Practice Address - Street 1:250 S. SUNNY SLOPE RD
Practice Address - Street 2:#128
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-782-2820
Practice Address - Fax:262-782-6937
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor