MEDICARE: TIMOTHY ENARSON

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	101YM0800X	Mental Health Counselor	178.018520	IL

General Provider Information

NPI Number	:	1124890033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ENARSON

Provider Business Mailing Address
First Line	:	1139 DARROW AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-1111
Country	:	US
Telephone Number	:	847-565-9048
Fax Number	:

Provider Business Practice Location Address
First Line	:	4256 N ARLINGTON HEIGHTS RD STE 101
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1399
Country	:	US
Telephone Number	:	847-295-1600
Fax Number	:

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

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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Directions to “ TIMOTHY ENARSON ” Practice Location

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