Healthcare Provider Details

I. General information

NPI: 1194029553
Provider Name (Legal Business Name): MR. TIMOTHY DANIEL PLANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIM D. PLANT LICSW

II. Dates (important events)

Enumeration Date: 12/28/2010
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2586 7TH AVE E SUITE 302
NORTH ST PAUL MN
55109-3083
US

IV. Provider business mailing address

2586 7TH AVE E SUITE 302
NORTH ST PAUL MN
55109-3083
US

V. Phone/Fax

Practice location:
  • Phone: 651-633-7300
  • Fax: 651-633-7301
Mailing address:
  • Phone: 651-633-7300
  • Fax: 651-633-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: