Healthcare Provider Details

I. General information

NPI: 1568594372
Provider Name (Legal Business Name): TAMI RA BAHR LCSW, CSAC, ICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ENTERPRISE LN STE 210
MADISON WI
53719-1143
US

IV. Provider business mailing address

6410 ENTERPRISE LN STE 210
MADISON WI
53719-1143
US

V. Phone/Fax

Practice location:
  • Phone: 608-400-3672
  • Fax: 608-422-4006
Mailing address:
  • Phone: 608-400-3672
  • Fax: 608-422-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7135-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15259-135
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15135-132
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7135-123
License Number StateWI
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7135-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: