Carly R Tebo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

9566 Issued in WI

Practice address

7818 Moline Rd
Webster, WI 54893-8545

Phone

(715) 866-8301

Fax

(715) 866-8374

NPI assigned

Aug 14, 2018

Last updated

May 11, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Therapy Associates LLCGroup PAC ID 5395273536, 28 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Therapy Associates, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • New Richmond, WI
  • NPI 1215239736
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1003396631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 309",
            "city": "SIREN",
            "state": "WI",
            "postal_code": "548720309",
            "telephone_number": "715-349-7069",
            "fax_number": "888-625-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7818 MOLINE RD",
            "city": "WEBSTER",
            "state": "WI",
            "postal_code": "548938545",
            "telephone_number": "715-866-8301",
            "fax_number": "715-866-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEBO",
        "first_name": "CARLY",
        "middle_name": "R",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-14",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131124-121",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Steiner
• Dianna Kay Stumph, RN,BSN
• Kimberly M Stypula, LPN
• Megan Grace Taylor, M.S., P.C.
• Nicole Marie Taylor, NP
• Joseph Wiliam Tembreull, DDS
• Jessica Thoreson
• Cortney Tripp, MSED
• Erin M Vogland, NP
• Kiah Weseli, PHARMD

• Clinical Social Worker in Webster, WI
• Providers in Webster, WI by specialty
• Clinical Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.