Healthcare Provider Details

I. General information

NPI: 1033368469
Provider Name (Legal Business Name): TIMOTHY VANRHEENEN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 ROCK SPRING RD SUITE A6
FOREST HILL MD
21050-2631
US

IV. Provider business mailing address

151 W COUNTY LINE RD
HATBORO PA
19040-1807
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-2493
  • Fax:
Mailing address:
  • Phone: 267-518-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001051
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLCM455
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: