Provider Demographics
NPI:1831204296
Name:RHULE, J SCOTT (MA, LCSW, CSAC, ICS)
Entity type:Individual
Prefix:MR
First Name:J SCOTT
Middle Name:
Last Name:RHULE
Suffix:
Gender:M
Credentials:MA, LCSW, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WARREN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-3084
Mailing Address - Country:US
Mailing Address - Phone:920-219-4440
Mailing Address - Fax:920-219-4553
Practice Address - Street 1:111 WARREN ST STE 2
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3084
Practice Address - Country:US
Practice Address - Phone:920-219-4440
Practice Address - Fax:920-219-4553
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11335101YA0400X
WI2284-1231041C0700X
WI2285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11335-132OtherCLINICAL SUBSTANCE ABUSE COUNSELOR (CSAC)
WI40970600Medicaid
WI11644-135OtherINDEPENDENT CLINICAL SUPERVISOR (ICS)
WI2284-123OtherLCSW LICENSE
CA32008OtherLICENSED MARRIAGE AND FAMILY THERAPIST (LMFT) INACTIVE STATUS