Provider Demographics
NPI:1952478687
Name:DOUGHMAN, THOMAS A (LMFT, LCSW, SAC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:DOUGHMAN
Suffix:
Gender:M
Credentials:LMFT, LCSW, SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4816 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54169-9750
Mailing Address - Country:US
Mailing Address - Phone:920-716-3748
Mailing Address - Fax:920-430-2015
Practice Address - Street 1:2555 E CALUMET ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-4748
Practice Address - Country:US
Practice Address - Phone:920-716-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13090-131101YA0400X
WI2951-1231041C0700X
WI431-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39781800Medicaid