Healthcare Provider Details

I. General information

NPI: 1942369988
Provider Name (Legal Business Name): PAUL A DEUTSCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RAILROAD AVE
VIROQUA WI
54665-1449
US

IV. Provider business mailing address

1707 MAIN ST
LA CROSSE WI
54601-4200
US

V. Phone/Fax

Practice location:
  • Phone: 608-301-5062
  • Fax:
Mailing address:
  • Phone: 608-785-0001
  • Fax: 608-785-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3559-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: