Healthcare Provider Details

I. General information

NPI: 1245341205
Provider Name (Legal Business Name): OCEANHAWK COUNSELING ALTERNATIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 DEER POINT DR STE A
STOUGHTON WI
53589-3773
US

IV. Provider business mailing address

3185 DEER POINT DR STE A
STOUGHTON WI
53589-3773
US

V. Phone/Fax

Practice location:
  • Phone: 608-873-7838
  • Fax: 877-674-2177
Mailing address:
  • Phone: 608-873-7838
  • Fax: 877-674-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1453
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3118
License Number StateWI

VIII. Authorized Official

Name: MS. JEAN A DAUTE
Title or Position: CO-OWNER AND CLINICAL DIRECTOR
Credential: MS LPC CSAC MAC ICS
Phone: 608-873-7838