Provider Demographics
NPI:1316580418
Name:TRIQUESTRIAN, LLC
Entity type:Organization
Organization Name:TRIQUESTRIAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:RA
Authorized Official - Last Name:BAHR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC, ICS
Authorized Official - Phone:608-206-4724
Mailing Address - Street 1:1408 ASHBURN WAY
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-2263
Mailing Address - Country:US
Mailing Address - Phone:608-206-4724
Mailing Address - Fax:608-422-4006
Practice Address - Street 1:6410 ENTERPRISE LN STE 210
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1143
Practice Address - Country:US
Practice Address - Phone:608-400-3672
Practice Address - Fax:608-422-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty