Provider Demographics
NPI:1790009546
Name:PAPE, MALISA MURRAY (LPC)
Entity type:Individual
Prefix:
First Name:MALISA
Middle Name:MURRAY
Last Name:PAPE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MALISA
Other - Middle Name:MARIE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1011 N 8TH ST
Mailing Address - Street 2:COUNTY OF SHEBOYGAN-HEALTH AND HUMAN SERVICES
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4006
Mailing Address - Country:US
Mailing Address - Phone:920-459-6403
Mailing Address - Fax:920-459-4353
Practice Address - Street 1:1011 N 8TH ST
Practice Address - Street 2:COUNTY OF SHEBOYGAN-HEALTH AND HUMAN SERVICES
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4006
Practice Address - Country:US
Practice Address - Phone:920-459-6403
Practice Address - Fax:920-459-4353
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4301-125101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12079522OtherCAQH