MEDICARE: TIM R. HODGES PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	1778	KS
2	103TC0700X	Clinical Psychologist	1778	KS
3	103TP2701X	Group Psychotherapy Psychologist	1778	KS

General Provider Information

NPI Number	:	1841420353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM R. HODGES PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 65
Second Line	:	BAKER UNIVERSITY
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-0065
Country	:	US
Telephone Number	:	785-594-8365
Fax Number	:	785-594-8314

Provider Business Practice Location Address
First Line	:	519 GROVE STREET
Second Line	:
City	:	BALDWIN CITY
State	:	KS
Zip	:	66006-0065
Country	:	US
Telephone Number	:	785-594-8365
Fax Number	:	785-594-8314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2009
Last Update Date	:	07/17/2009

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