Provider Demographics
NPI:1972654150
Name:SHEA, MARIA KAY (LPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KAY
Last Name:SHEA
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:N8898 250TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54767-8111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 HOSFORD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-9319
Practice Address - Country:US
Practice Address - Phone:715-505-7268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2895125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health