Provider Demographics
NPI:1962026161
Name:BARES, ALLYSEN (LPC)
Entity Type:Individual
Prefix:
First Name:ALLYSEN
Middle Name:
Last Name:BARES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 WATSON ST STE D
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1516
Mailing Address - Country:US
Mailing Address - Phone:929-896-0189
Mailing Address - Fax:
Practice Address - Street 1:3475 OMRO RD STE 400
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7126
Practice Address - Country:US
Practice Address - Phone:920-267-3470
Practice Address - Fax:920-267-3480
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8578-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100160777Medicaid