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General NPI Number Information
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NPI Number | 1942352869
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Entity Type | Organization
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Legal Business Name | STOUGHTON FAMILY COUNSELING SERVICES
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 1520 VERNON ST
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City | STOUGHTON
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State | WI
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Zip | 53589-2260
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Country | US
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Telephone | 608-873-6422
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 VERNON ST
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City | STOUGHTON
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State | WI
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Zip | 53589-2260
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Country | US
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Telephone | 608-873-6422
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. DAVID W DRUCKENBROD
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Credential | LCSW
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Telephone | 608-873-1844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1883
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License Number State | WI
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