Provider Demographics
NPI:1992886162
Name:MAAS, KELLY ANN (MSE, LPC, SAS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MAAS
Suffix:
Gender:F
Credentials:MSE, LPC, SAS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:KITCHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 EAST GREEN BAY ST.,
Mailing Address - Street 2:STE 191 SYNERGY COUNSELING SERVICES, SC
Mailing Address - City:SHAWANO,
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3881
Mailing Address - Country:US
Mailing Address - Phone:715-526-5466
Mailing Address - Fax:715-526-5545
Practice Address - Street 1:1415 EAST GREEN BAY ST.,
Practice Address - Street 2:STE 191 SYNERGY COUNSELING SERVICES, SC
Practice Address - City:SHAWANO,
Practice Address - State:WI
Practice Address - Zip Code:54166-3881
Practice Address - Country:US
Practice Address - Phone:715-526-5466
Practice Address - Fax:715-526-5545
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13230130101Y00000X
WI3243125101Y00000X
WI3243-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11681743OtherCAQH
WI40998400Medicaid