Provider Demographics
NPI:1538499835
Name:ROUM BRUE, MARCIA (LPC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:ROUM BRUE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GISHOLT DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4835
Mailing Address - Country:US
Mailing Address - Phone:608-223-1506
Mailing Address - Fax:608-223-1745
Practice Address - Street 1:6400 GISHOLT DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53713-4835
Practice Address - Country:US
Practice Address - Phone:608-223-1506
Practice Address - Fax:608-223-1745
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4319-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional