Provider Demographics
NPI:1669524393
Name:ROBERTS, THOMAS BARRETT (LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BARRETT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2858
Mailing Address - Country:US
Mailing Address - Phone:608-783-2186
Mailing Address - Fax:608-781-3405
Practice Address - Street 1:1401 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2858
Practice Address - Country:US
Practice Address - Phone:608-783-2186
Practice Address - Fax:608-781-3405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI724101YA0400X
WI3841-1231041C0700X
WI59-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist