Provider Demographics
NPI:1124272026
Name:PUFAHL, DONNA J (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:J
Last Name:PUFAHL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-353-8117
Mailing Address - Fax:262-877-3933
Practice Address - Street 1:5419 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-353-8117
Practice Address - Fax:262-877-3933
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001147101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor