Provider Demographics
NPI:1861562449
Name:BAUER, MICHAEL T (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:T
Last Name:BAUER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:N6341 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:ARKANSAW
Mailing Address - State:WI
Mailing Address - Zip Code:54721-9208
Mailing Address - Country:US
Mailing Address - Phone:715-832-2084
Mailing Address - Fax:715-838-8423
Practice Address - Street 1:3410 OAKWOOD MALL DR STE 700
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2617
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:715-832-6680
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1818-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3970400Medicaid