Provider Demographics
NPI:1033820014
Name:MASTIN, CARA ELISE (MS, LPC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:ELISE
Last Name:MASTIN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8579 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2209
Mailing Address - Country:US
Mailing Address - Phone:920-663-2026
Mailing Address - Fax:
Practice Address - Street 1:8579 N 107TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2209
Practice Address - Country:US
Practice Address - Phone:920-663-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11385-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional