Healthcare Provider Details

I. General information

NPI: 1578495321
Provider Name (Legal Business Name): MARA JONES LPC-IT, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 CHESTNUT ST
WEST BEND WI
53095-3014
US

IV. Provider business mailing address

1622 CHESTNUT ST
WEST BEND WI
53095-3014
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-9800
  • Fax: 262-306-9802
Mailing address:
  • Phone: 262-306-9800
  • Fax: 262-306-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7930-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: