Healthcare Provider Details

I. General information

NPI: 1043794324
Provider Name (Legal Business Name): JOHN MICHAEL DUFFEY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 07/01/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILD & FAMILY THERAPEUTIC SYSTEMS 4811 S 76 STREET #305
GREENFIELD WI
53220-4364
US

IV. Provider business mailing address

7100 W BLUEMOUND RD
WAUWATOSA WI
53213-3723
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-7741
  • Fax:
Mailing address:
  • Phone: 414-248-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7094-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: