Provider Demographics
NPI:1770063125
Name:PIPER, MYTHE
Entity type:Individual
Prefix:
First Name:MYTHE
Middle Name:
Last Name:PIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S WITTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5241
Mailing Address - Country:US
Mailing Address - Phone:715-207-7528
Mailing Address - Fax:
Practice Address - Street 1:2001 S CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4973
Practice Address - Country:US
Practice Address - Phone:715-384-2818
Practice Address - Fax:715-384-2724
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3940-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional