MEDICARE: STACEY LYNN DULIN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6774-125

General Provider Information

NPI Number	:	1609214386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LYNN DULIN LPC

Provider Business Mailing Address
First Line	:	309 JOSHUA CIR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	735 LOIS DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1177
Country	:	US
Telephone Number	:	608-669-8508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2013
Last Update Date	:	12/17/2019

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