Healthcare Provider Details

I. General information

NPI: 1497334379
Provider Name (Legal Business Name): TIMOTHY MICHAEL KILLIAN LLMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10801 S SAGINAW ST STE 5
GRAND BLANC MI
48439-8126
US

IV. Provider business mailing address

10801 S SAGINAW ST STE D
GRAND BLANC MI
48439-8126
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-4074
  • Fax:
Mailing address:
  • Phone: 810-771-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851118251
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802091095
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: