Individual provider Active NPI

Tamara L Kolesar, LPC-IT, SAC-IT

  • Mental Health Counselor
  • Bayfield, WI
National Provider Identifier
1255996526
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
4237-226 Issued in WI
Practice address
36745 Aiken Rd
Bayfield, WI 54814-4579
Phone
(715) 779-3707
Fax
(715) 779-3362
NPI assigned
May 2, 2019
Last updated
May 2, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 18710-130 WI
Mental Health Counselor 101YM0800X 4237-226 WI Primary

Addresses

Primary practice location

36745 Aiken Rd
Bayfield, WI 54814-4579

Mailing address

36745 Aiken Rd
Bayfield, WI 54814-4579
Phone (715) 779-3707

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241223000929 WI Practitioner - Marriage and Family Therapist 8820525322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

36745 Aiken Rd
Bayfield, WI 54814-4579
Phone 71577937072324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18710-130WIMDAddiction (Substance Use Disorder) Counselor
4237-226WIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Red Cliff Band of Lake Superior Chippewa Indians CurrentSince Oct 3, 2024 Accepting new patients
Red Cliff Band of Lake Superior Chippewa Indians Addiction (Substance Use Disorder) CurrentSince Oct 3, 2024 Accepting new patients

Locations

36745 Aiken Rd
Bayfield, WI 54814
Phone (715) 779-3707

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556755200000",
    "number": "1255996526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36745 AIKEN RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144579",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36745 AIKEN RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144579",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLESAR",
        "first_name": "TAMARA",
        "middle_name": "L",
        "credential": "LPC-IT, SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18710-130",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WI",
            "license": "4237-226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bayfield, WI

Sources for this page

Verify at the official NPI Registry.