Timothy John Koller, MS, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2649-125 Issued in WI

Practice address

401 5TH St
Ste 235
Wausau, WI 54403-5470

Phone

(715) 849-3311

Fax

(715) 849-8414

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Mental Health Counselor

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Centre for Well-Being, IncGroup PAC ID 6002083920, 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• The Centre for Well-Being, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wausau, WI
  • NPI 1144426495
  Medicare reassignment Care Compare group NPD
• Catholic Charities of the Diocese of la Crosse, Inc.

  • Clinical Social Worker
  • Wausau, WI
  • NPI 1558508499

  Professional

  NPD (past)

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226361600000",
    "number": "1407918998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1127",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530821127",
            "telephone_number": "920-457-6750",
            "fax_number": "920-457-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 5TH ST",
            "address_2": "STE 235",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544035470",
            "telephone_number": "715-849-3311",
            "fax_number": "715-849-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2008-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "2649-125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39756000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kohl Dental LLC (Gary J Kohl DDS)
• Gary J Kohl, DDS
• Daniel Lee Kohn, LCSW, CADC III
• Jamie Lois Ann Kolka I, OTR, CHT
• Kellie Kolka, RN
• Robert E Kollpainter, PA-C
• Sheryl R Konig, MSW, APSW
• Lee Ann Kopecko
• Angela Kopetzky, RN
• Rebecca J Kopp, LPC-IT

• Professional Counselor in Wausau, WI
• Providers in Wausau, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; 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.