Provider Demographics
NPI:1073148656
Name:PAULI, MARY T (LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:PAULI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11101 N SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9002
Mailing Address - Country:US
Mailing Address - Phone:608-884-3441
Mailing Address - Fax:
Practice Address - Street 1:111 W FULTON ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-1876
Practice Address - Country:US
Practice Address - Phone:608-561-6614
Practice Address - Fax:608-561-6642
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010034101YM0800X
WI7545-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health