| Oceanhawk Counseling Alternatives Llc | |
|
3185 Deer Point Dr Ste A Stoughton WI 53589-3773 | |
| (608) 873-7838 | |
| (877) 674-2177 |
| Full Name | Oceanhawk Counseling Alternatives Llc |
|---|---|
| Speciality | Counselor |
| Location | 3185 Deer Point Dr Ste A, Stoughton, Wisconsin |
| Authorized Official Name and Position | Jean A Daute (CO-OWNER AND CLINICAL DIRECTOR) |
| Authorized Official Contact | 6088737838 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oceanhawk Counseling Alternatives Llc 3185 Deer Point Dr Ste A Stoughton WI 53589-3773 Ph: (608) 873-7838 | Oceanhawk Counseling Alternatives Llc 3185 Deer Point Dr Ste A Stoughton WI 53589-3773 Ph: (608) 873-7838 |
| NPI Number | 1245341205 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 10/15/2021 |
| Certification Date | 10/15/2021 |
| Medicare PECOS PAC ID | 7810098886 |
|---|---|
| Medicare Enrollment ID | O20070720000112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245341205 | NPI | - | NPPES |
| 42246600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 1453 (Wisconsin) | Primary |
| 101YP2500X | Counselor - Professional | 3118 (Wisconsin) | Secondary |
| Provider Name | Sidney Boersma |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992800775 PECOS PAC ID: 3870545460 Enrollment ID: I20050211000117 |
| Provider Name | Amanda Isunza |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881085959 PECOS PAC ID: 9234480260 Enrollment ID: I20181001002324 |
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