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General NPI Number Information
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NPI Number | 1861487647
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Entity Type | Individual
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Provider Name | MARK JOSEPH MOHAPP LCSW, CSAC
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 1271 WISCONSIN ST B
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1748
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Country | US
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Telephone | 262-215-0826
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Fax |
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Provider Business Mailing Address
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Address Line | 1271 WISCONSIN ST B
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1748
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Country | US
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Telephone | 262-215-0826
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Fax |
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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 | 2019
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 116-123
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.004395
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2019-132
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 7099-135
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License Number State | WI
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