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General NPI Number Information
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NPI Number | 1992886162
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Entity Type | Individual
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Provider Name | KELLY ANN MAAS MSE, LPC, SAS
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/04/2009
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Provider Practice Location Address
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Address Line | 1415 EAST GREEN BAY ST., STE 191 SYNERGY COUNSELING SERVICES, SC
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City | SHAWANO
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State | WI
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Zip | 54166-3881
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Country | US
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Telephone | 715-526-5466
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Fax | 715-526-5545
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Provider Business Mailing Address
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Address Line | 1415 EAST GREEN BAY ST., STE 191 SYNERGY COUNSELING SERVICES, SC
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City | SHAWANO
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State | WI
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Zip | 54166-3881
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Country | US
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Telephone | 715-526-5466
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Fax | 715-526-5545
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 13230130
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3243125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 3243-125
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License Number State | WI
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