Provider Demographics
NPI:1861487647
Name:MOHAPP, MARK JOSEPH (LCSW, CSAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOSEPH
Last Name:MOHAPP
Suffix:
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 WISCONSIN ST
Mailing Address - Street 2:B
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1748
Mailing Address - Country:US
Mailing Address - Phone:262-215-0826
Mailing Address - Fax:
Practice Address - Street 1:1271 WISCONSIN ST
Practice Address - Street 2:B
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1748
Practice Address - Country:US
Practice Address - Phone:262-215-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019101YA0400X
WI116-1231041C0700X
IL149.0043951041C0700X
WI2019-132101YA0400X
WI7099-135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
137909000OtherMAGELLAN BID HEALTH
WI39269100OtherCENPATICO
WI39269100OtherHIRSP
WI10670OtherDEAN CARE
60158OtherCIGNA
A917403OtherVALUE OPTIONS
WI39269100Medicaid