Provider Demographics
NPI:1942352869
Name:STOUGHTON FAMILY COUNSELING SERVICES
Entity Type:Organization
Organization Name:STOUGHTON FAMILY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:DRUCKENBROD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-873-1844
Mailing Address - Street 1:1520 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2260
Mailing Address - Country:US
Mailing Address - Phone:608-873-6422
Mailing Address - Fax:
Practice Address - Street 1:1520 VERNON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2260
Practice Address - Country:US
Practice Address - Phone:608-873-6422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1883261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42111800Medicaid
WI000084301Medicare ID - Type Unspecified