Individual
MR. TIMOTHY JOHN KOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Contact information
Practice address
401 5TH ST, STE 235, WAUSAU, WI 54403-5470
(715) 849-3311
(715) 849-8414
Mailing address
PO BOX 1127, SHEBOYGAN, WI 53082-1127
(920) 457-6750
(920) 457-8350
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2649-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39756000
—
WI
Enumeration date
12/14/2006
Last updated
11/11/2008
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