Individual
TARA L THIELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4076 KOTHLOW AVE, MENOMONIE, WI 54751-3090
(715) 235-4537
Mailing address
2502 SUNSET DR, EAU CLAIRE, WI 54703-5850
(715) 563-8790
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
7668-125
WI
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
7668-125
WI
Other
Enumeration date
12/05/2019
Last updated
10/16/2024
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