Healthcare Provider Details

I. General information

NPI: 1730336926
Provider Name (Legal Business Name): TIMOTHY W MCVAY MA, LLP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 12/10/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 NILES AVE SUITE 102
ST JOSEPH MI
49085-1615
US

IV. Provider business mailing address

1901 NILES AVE SUITE 102
ST JOSEPH MI
49085-1615
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-7200
  • Fax: 269-982-0202
Mailing address:
  • Phone: 269-982-7200
  • Fax: 269-982-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401010619
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401010619
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361004438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: