Provider Demographics
NPI:1578640454
Name:PAVLONS, TRICIA J (MS, LPC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:J
Last Name:PAVLONS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:HOOYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1669 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2044
Mailing Address - Country:US
Mailing Address - Phone:414-232-2328
Mailing Address - Fax:
Practice Address - Street 1:3900 W BROWN DEER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53209-1220
Practice Address - Country:US
Practice Address - Phone:414-540-2170
Practice Address - Fax:414-540-2171
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3548-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40979400Medicaid