Provider Demographics
NPI:1518670041
Name:TABBERT, KEYARA J (LMFT)
Entity type:Individual
Prefix:
First Name:KEYARA
Middle Name:J
Last Name:TABBERT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W10174 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618-9709
Mailing Address - Country:US
Mailing Address - Phone:608-344-0053
Mailing Address - Fax:
Practice Address - Street 1:304 BICKFORD ST
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:WI
Practice Address - Zip Code:53950-1533
Practice Address - Country:US
Practice Address - Phone:608-562-3976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2224-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist