MEDICARE: MR. TIMOTHY WILLIAM LOEBS

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
1	101YP2500X	Professional Counselor	2006	SC

General Provider Information

NPI Number	:	1114977394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY WILLIAM LOEBS

Provider Business Mailing Address
First Line	:	PO BOX 14452
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29587-4452
Country	:	US
Telephone Number	:	843-650-8940
Fax Number	:	843-651-5398

Provider Business Practice Location Address
First Line	:	1945 GLENNS BAY RD
Second Line	:
City	:	SURFSIDE BEACH
State	:	SC
Zip	:	29575-4833
Country	:	US
Telephone Number	:	843-650-8940
Fax Number	:	843-651-5398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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