Provider Demographics
NPI:1760629026
Name:MAROHL, KIM (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MAROHL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-1310
Mailing Address - Country:US
Mailing Address - Phone:920-278-2620
Mailing Address - Fax:920-278-7886
Practice Address - Street 1:321 SAINT GEORGE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-1310
Practice Address - Country:US
Practice Address - Phone:920-278-2620
Practice Address - Fax:920-278-7886
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4239-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760629026Medicaid