Healthcare Provider Details

I. General information

NPI: 1487618070
Provider Name (Legal Business Name): TIMOTHY RICHARD CEFAI FLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD SUITE 111
LANSING MI
48910-6818
US

IV. Provider business mailing address

4129 OKEMOS RD SUITE 6
OKEMOS MI
48864-2822
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8200
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-333-4858
  • Fax: 517-999-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301008331
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: