Healthcare Provider Details

I. General information

NPI: 1881718294
Provider Name (Legal Business Name): CRYSTAL LYNN DALEBROUX LMFT CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7818 BIG SKY DR STE 101
MADISON WI
53719-2840
US

IV. Provider business mailing address

1434 BELLFLOWER LN
MADISON WI
53719-4539
US

V. Phone/Fax

Practice location:
  • Phone: 608-203-6267
  • Fax: 608-203-6696
Mailing address:
  • Phone: 608-203-6267
  • Fax: 608-203-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15321-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number773-124
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: