Provider Demographics
NPI:1881718294
Name:DALEBROUX, CRYSTAL LYNN (LMFT CSAC)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNN
Last Name:DALEBROUX
Suffix:
Gender:F
Credentials:LMFT CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 BELLFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4539
Mailing Address - Country:US
Mailing Address - Phone:608-203-6267
Mailing Address - Fax:608-203-6696
Practice Address - Street 1:7818 BIG SKY DR STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2840
Practice Address - Country:US
Practice Address - Phone:608-203-6267
Practice Address - Fax:608-203-6696
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI773-124101YM0800X
WI15321-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100002735Medicaid