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General NPI Number Information
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NPI Number | 1487070439
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Entity Type | Individual
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Provider Name | LAMONT MCPHERON
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Gender | Male
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Dates
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Enumeration Date | 03/14/2014
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | S1597 HANSON RD
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City | WESTBY
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State | WI
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Zip | 54667-8396
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Country | US
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Telephone | 608-574-0582
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Fax | 608-634-6918
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Provider Business Mailing Address
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Address Line | 415 E TERHUNE ST
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City | VIROQUA
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State | WI
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Zip | 54665
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Country | US
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Telephone | 608-606-3375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2084-226
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License Number State | WI
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