Provider Demographics
NPI:1053064923
Name:BOSCH, TIMOTHY M (LPC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:BOSCH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7485
Mailing Address - Country:US
Mailing Address - Phone:641-891-9127
Mailing Address - Fax:
Practice Address - Street 1:3029 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7485
Practice Address - Country:US
Practice Address - Phone:641-891-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6915-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health