Provider Demographics
NPI:1356184824
Name:TOBIAS, DEVAN (MFT-IT)
Entity type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 BLUE ASTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4670
Mailing Address - Country:US
Mailing Address - Phone:608-957-3943
Mailing Address - Fax:
Practice Address - Street 1:251 PROGRESS WAY STE 102
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2520
Practice Address - Country:US
Practice Address - Phone:608-849-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1103-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist