Healthcare Provider Details

I. General information

NPI: 1790009546
Provider Name (Legal Business Name): MALISA MURRAY PAPE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALISA MARIE MURRAY LPC

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N 8TH ST COUNTY OF SHEBOYGAN-HEALTH AND HUMAN SERVICES
SHEBOYGAN WI
53081-4006
US

IV. Provider business mailing address

1011 N 8TH ST COUNTY OF SHEBOYGAN-HEALTH AND HUMAN SERVICES
SHEBOYGAN WI
53081-4006
US

V. Phone/Fax

Practice location:
  • Phone: 920-459-6403
  • Fax: 920-459-4353
Mailing address:
  • Phone: 920-459-6403
  • Fax: 920-459-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4301-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4301-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: