| Tall Pines Behavioral Health Llc | |
|
100 N 72nd Ave Wausau WI 54401-9042 | |
| (715) 301-0267 | |
| Not Available |
| Full Name | Tall Pines Behavioral Health Llc |
|---|---|
| Speciality | Psychologist |
| Location | 100 N 72nd Ave, Wausau, Wisconsin |
| Authorized Official Name and Position | Dakota Joseph Kaiser (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7155810155 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tall Pines Behavioral Health Llc 100 N 72nd Ave Wausau WI 54401-9042 Ph: (715) 301-0267 | Tall Pines Behavioral Health Llc 100 N 72nd Ave Wausau WI 54401-9042 Ph: (715) 301-0267 |
| NPI Number | 1215519764 |
|---|---|
| Provider Enumeration Date | 04/24/2021 |
| Last Update Date | 11/14/2024 |
| Certification Date | 11/14/2024 |
| Medicare PECOS PAC ID | 8123554904 |
|---|---|
| Medicare Enrollment ID | O20241204002580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215519764 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Dakota J Kaiser |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033566088 PECOS PAC ID: 4587065222 Enrollment ID: I20210701001272 |
| Provider Name | Rachel F Voit |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740955590 PECOS PAC ID: 6103214358 Enrollment ID: I20211021000666 |
| Provider Name | Rachel Nicole Sheldon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396176475 PECOS PAC ID: 3577099357 Enrollment ID: I20250317001885 |
| Provider Name | Julia Van Liew |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538672928 PECOS PAC ID: 9436671492 Enrollment ID: I20250319001518 |
| Provider Name | Hannah Mary Vestal |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154988871 PECOS PAC ID: 5395267934 Enrollment ID: I20250324001568 |
| Provider Name | Jennifer Lois Lynada Major |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063178523 PECOS PAC ID: 0547783912 Enrollment ID: I20250326001729 |
| Provider Name | Raven Marie Krautkramer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306660295 PECOS PAC ID: 3577086966 Enrollment ID: I20250326002279 |
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