Provider Demographics
NPI:1396258240
Name:OBERT, TIM ALLEN (MS, CPS, SAC, CCDS)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:ALLEN
Last Name:OBERT
Suffix:
Gender:M
Credentials:MS, CPS, SAC, CCDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-3501
Mailing Address - Country:US
Mailing Address - Phone:815-238-7891
Mailing Address - Fax:
Practice Address - Street 1:1307 STATE ROAD 69
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9328
Practice Address - Country:US
Practice Address - Phone:608-527-2401
Practice Address - Fax:608-527-1939
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16363-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)