Provider Demographics
NPI:1588852560
Name:BAUTCH, TIMOTHY JAY (LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:BAUTCH
Suffix:
Gender:M
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 APPLEGATE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-5008
Mailing Address - Country:US
Mailing Address - Phone:608-221-1500
Mailing Address - Fax:608-221-1515
Practice Address - Street 1:1334 APPLEGATE RD STE 101
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-5008
Practice Address - Country:US
Practice Address - Phone:608-221-1500
Practice Address - Fax:608-221-1515
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14528101YA0400X
WI3921-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)