Provider Demographics
NPI:1407913312
Name:GUILFOOSE, DAVID MICHAEL (MAP MED MHP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:GUILFOOSE
Suffix:
Gender:M
Credentials:MAP MED MHP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 WISCONSIN AVE
Mailing Address - Street 2:MOON TREE COUNSELING
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-1487
Mailing Address - Country:US
Mailing Address - Phone:608-256-5115
Mailing Address - Fax:608-256-5116
Practice Address - Street 1:401 WISCONSIN AVE
Practice Address - Street 2:MOON TREE COUNSELING
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-1487
Practice Address - Country:US
Practice Address - Phone:608-256-5115
Practice Address - Fax:608-256-5116
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WARC00047877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional