Provider Demographics
NPI:1184002560
Name:SMUGALA, MARIAH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:SMUGALA
Suffix:
Gender:F
Credentials:MS, LPC
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 65
Mailing Address - Street 2:
Mailing Address - City:OWEN
Mailing Address - State:WI
Mailing Address - Zip Code:54460-0065
Mailing Address - Country:US
Mailing Address - Phone:715-229-0330
Mailing Address - Fax:715-229-0331
Practice Address - Street 1:112 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OWEN
Practice Address - State:WI
Practice Address - Zip Code:54460-9776
Practice Address - Country:US
Practice Address - Phone:715-229-0330
Practice Address - Fax:715-229-0331
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1184002560Medicaid