MEDICARE: DR. DONALD MICHAEL NORMAN PH.D., LPC, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2876-125	WI
2	106H00000X	Marriage & Family Therapist	653-124	WI

General Provider Information

NPI Number	:	1104918507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD MICHAEL NORMAN PH.D., LPC, LMFT

Provider Business Mailing Address
First Line	:	162 W MAIN ST
Second Line	:	SUITE G
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1995
Country	:	US
Telephone Number	:	262-473-5005
Fax Number	:	262-473-5005

Provider Business Practice Location Address
First Line	:	162 W MAIN ST
Second Line	:	SUITE G
City	:	WHITEWATER
State	:	WI
Zip	:	53190-1995
Country	:	US
Telephone Number	:	262-473-5005
Fax Number	:	262-473-5005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	10/21/2008

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