| Doctor Name: | MR. CHARLES D LIPFORD |
| NPI Number: | 1003079708 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSAC |
| License Number: | 302375 |
| Business Practice Address: | 220 E La Crosse St. Juneau County Human Services Mauston, WI - 539482101 |
| Business Phone Number: | 6088472400 |
| Business Fax Number: | 6088479599 |
| Mailing Address: | 220 E La Crosse St., Juneau County Human Services MAUSTON |
| State: | WI |
| Postal Code: | 539482101 |
| Phone Number: | 6088472400 |
| Fax Number: | 6088479599 |
| NPI Enumeration Date: | 07/03/2008 |
| NPI Last Update Date: | 06/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 302375 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |