Provider Demographics
NPI:1275148736
Name:MOUA, SHERZING (LPC-IT)
Entity Type:Individual
Prefix:
First Name:SHERZING
Middle Name:
Last Name:MOUA
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3205
Mailing Address - Country:US
Mailing Address - Phone:262-353-9701
Mailing Address - Fax:
Practice Address - Street 1:724 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3205
Practice Address - Country:US
Practice Address - Phone:262-353-9701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4733-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional