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General NPI Number Information
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NPI Number | 1114145612
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Entity Type | Individual
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Provider Name | MARK STEVEN FOSSIE MS, LMFT, CSAC, ICS
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2821 N 4TH ST 516
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City | MILWAUKEE
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State | WI
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Zip | 53212-2362
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Country | US
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Telephone | 414-263-6000
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Fax | 414-263-2270
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Provider Business Mailing Address
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Address Line | 2821 N 4TH ST 516
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City | MILWAUKEE
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State | WI
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Zip | 53212-2362
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Country | US
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Telephone | 414-263-6000
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Fax | 414-263-2270
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14971-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 402
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 460-124
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License Number State | WI
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