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NPI Code Detail

MEDICARE: TIMOTHY HOLLERN

MEDICARE: TIMOTHY HOLLERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1104771831
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY HOLLERN
Provider Business Mailing Address
First Line : 277 RIVER PINE DR
Second Line :
City : LOWELL
State : MI
Zip : 49331-9574
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4234 CASCADE RD SE STE 3
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-8384
Country : US
Telephone Number : 616-202-4840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2026
Last Update Date : 03/04/2026

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Directions to “ TIMOTHY HOLLERN ” Practice Location

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