Provider Demographics
NPI:1750874822
Name:FLOYD, MAISIE MAE (LPC, SAC)
Entity type:Individual
Prefix:
First Name:MAISIE
Middle Name:MAE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LPC, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5014 NORTHVIEW RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:WI
Mailing Address - Zip Code:53019-1536
Mailing Address - Country:US
Mailing Address - Phone:920-904-6247
Mailing Address - Fax:
Practice Address - Street 1:199 COUNTY ROAD DF FL 3
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9512
Practice Address - Country:US
Practice Address - Phone:920-386-4094
Practice Address - Fax:920-386-4564
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17098-131101YA0400X
WI7877-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)