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General NPI Number Information
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NPI Number | 1346540556
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Entity Type | Individual
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Provider Name | TIMOTHY THEYE LCSW, LMHC, LCAC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 2314 LAKE AVE STE B
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City | FORT WAYNE
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State | IN
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Zip | 46805-5439
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Country | US
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Telephone | 260-450-6068
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Fax | 260-422-4309
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Provider Business Mailing Address
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Address Line | 2314 LAKE AVE STE B
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City | FORT WAYNE
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State | IN
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Zip | 46805-5439
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Country | US
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Telephone | 260-450-6068
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Fax | 260-422-4309
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004130A
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License Number State | IN
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