NPIMap

Organization Active NPI

Tall Pines Behavioral Health LLC

  • Health Service Psychologist
  • Wausau, WI
National Provider Identifier
1215519764
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service PsychologistTaxonomy code 103TH0100X
Legal business name
TALL PINES BEHAVIORAL HEALTH LLC
Practice address
100 N 72ND Ave
Wausau, WI 54401-9042
Phone
(715) 301-0267
NPI assigned
Apr 24, 2021
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Dakota J Kaiser, PHDNPI 1033566088
Title
Managing Partner
Phone
(715) 301-0267

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Health Service PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TH0100X Primary

Addresses

Primary practice location

100 N 72ND Ave
Wausau, WI 54401-9042

Mailing address

100 N 72ND Ave
Wausau, WI 54401-9042
Phone (715) 301-0267

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241204002580 WI Part B Supplier - Clinic/Group Practice 8123554904 Receives reassigned benefits from 9 practitioners
Practice locations: Wausau, WI

National Provider Directory

National Provider Directory

Locations

100 N 72nd Ave
Wausau, WI 54401
Phone (715) 301-0267

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1619222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1215519764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N 72ND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544019042",
            "telephone_number": "715-301-0267",
            "fax_number": "844-444-0672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N 72ND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544019042",
            "telephone_number": "715-301-0267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALL PINES BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-24",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "KAISER",
        "authorized_official_first_name": "DAKOTA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "715-301-0267",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.