Provider Demographics
NPI:1831845742
Name:ALLARD, MARIAH (LPC-IT)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:ALLARD
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 GILLETTE ST APT 35
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3091
Mailing Address - Country:US
Mailing Address - Phone:920-728-4289
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-9200
Practice Address - Country:US
Practice Address - Phone:608-797-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5238-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health