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General NPI Number Information
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NPI Number | 1184356099
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Entity Type | Individual
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Provider Name | TIMOTHY THEISEN MA LLC CADC
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Gender | Male
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 122 N LANSING ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-1632
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Country | US
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Telephone | 989-240-0192
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N LANSING ST
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City | MT PLEASANT
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State | MI
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Zip | 48858-1631
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Country | US
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Telephone | 989-944-2950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6451022346
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License Number State | MI
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