Provider Demographics
NPI:1104918507
Name:NORMAN, DONALD MICHAEL (PHD, LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MICHAEL
Last Name:NORMAN
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 W MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1995
Mailing Address - Country:US
Mailing Address - Phone:262-473-5005
Mailing Address - Fax:262-473-5005
Practice Address - Street 1:162 W MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1995
Practice Address - Country:US
Practice Address - Phone:262-473-5005
Practice Address - Fax:262-473-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2876-125101YP2500X
WI653-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist