Healthcare Provider Details

I. General information

NPI: 1114325032
Provider Name (Legal Business Name): TIMOTHY FRANKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST STE 1800
FLINT MI
48507-2677
US

IV. Provider business mailing address

12055 BEECH DALY RD
REDFORD MI
48239-2429
US

V. Phone/Fax

Practice location:
  • Phone: 810-732-8336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301016882
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: