Basic Information
| Provider Information | |||||||||
| NPI: | 1457693368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOWARD | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | NORMAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 304 S NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486021570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897996542 | ||||||||
| FaxNumber: | 9897996681 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 S NIAGARA ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486021570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897996542 | ||||||||
| FaxNumber: | 9897996681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2013 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 382740531 | 05 | MI | MEDICAID |