MEDICARE: MARK NIMTZ PHD

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	4101006241	MI

General Provider Information

NPI Number	:	1366392755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK NIMTZ PHD

Provider Business Mailing Address
First Line	:	1127 SHADOW DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48085-1779
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 E 14 MILE RD
Second Line	:
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-7258
Country	:	US
Telephone Number	:	248-224-1842
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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