Healthcare Provider Details

I. General information

NPI: 1699045716
Provider Name (Legal Business Name): PAUL W GUYTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER MAIL STOP 116A
MADISON WI
53705-2254
US

IV. Provider business mailing address

2500 OVERLOOK TER MAIL STOP 116A
MADISON WI
53705-2254
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-2095
  • Fax: 608-251-0211
Mailing address:
  • Phone: 608-280-2095
  • Fax: 608-251-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number005212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: