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General NPI Number Information
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NPI Number | 1376973321
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Entity Type | Organization
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Legal Business Name | TIMOTHY J DAHEIM PA
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 2407 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-5721
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Country | US
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Telephone | 254-773-0764
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Fax | 254-935-2258
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | TEMPLE
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State | TX
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Zip | 76503-0204
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Country | US
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Telephone | 254-773-0764
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Fax | 254-935-2258
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY J DAHEIM
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Credential | PHD
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Telephone | 254-773-0764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 31399
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31399
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License Number State | TX
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