Provider Demographics
NPI:1922496066
Name:MUHAMMAD, MARY (LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MUHAMMAD
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:RODGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8266 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-3606
Mailing Address - Country:US
Mailing Address - Phone:262-292-1018
Mailing Address - Fax:
Practice Address - Street 1:3195 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2189
Practice Address - Country:US
Practice Address - Phone:262-646-9960
Practice Address - Fax:262-646-9961
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17350-130101YA0400X
101YP2500X
WI6631-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional