Individual provider · Type 1 NPI
Jacob J. Lichman Jr., CSAC IDP/AT
Addiction (Substance Use Disorder) Counselor · Montello, WI
NPI number
1306140967
Active
Practice location
N3829 State Road 22
Montello, WI 53949-9049
Fax (608) 297-2426
Mailing address
PO Box 57
Montello, WI 53949-0057
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Addiction (Substance Use Disorder) Counselor Primary | 101YA0400X | 1853-132 (WI) |
Addiction (Substance Use Disorder) Counselor: Definition to come...
Another provider at this address
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About NPI 1306140967
Jacob J. Lichman Jr., CSAC IDP/AT's National Provider Identifier is 1306140967, issued on Dec 22, 2010. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Montello, WI. The record was last updated on Dec 22, 2010.