MEDICARE: KENZIE M TIMM

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	101YM0800X	Mental Health Counselor	6401017477	MI

General Provider Information

NPI Number	:	1962045708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENZIE M TIMM

Provider Business Mailing Address
First Line	:	850 STEPHENSON HWY STE 210
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1151
Country	:	US
Telephone Number	:	248-585-3239
Fax Number	:	248-616-9759

Provider Business Practice Location Address
First Line	:	850 STEPHENSON HWY STE 210
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-1151
Country	:	US
Telephone Number	:	248-585-3239
Fax Number	:	248-585-3239

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

Provider Enumeration Date	:	10/24/2019
Last Update Date	:	10/24/2019

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Directions to “ KENZIE M TIMM ” Practice Location

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