Provider Demographics
NPI:1063991032
Name:K BARE LLC
Entity type:Organization
Organization Name:K BARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARILIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CSAC, NCC
Authorized Official - Phone:920-541-3677
Mailing Address - Street 1:1031 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1631
Mailing Address - Country:US
Mailing Address - Phone:920-541-3677
Mailing Address - Fax:920-541-3678
Practice Address - Street 1:1031 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1631
Practice Address - Country:US
Practice Address - Phone:920-541-3677
Practice Address - Fax:920-541-3678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K BARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health