MEDICARE: TIM AIELLO MA, LPC, NCC, ADHD-C

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	101Y00000X	Counselor	6401223954	MI

General Provider Information

NPI Number	:	1669048385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM AIELLO MA, LPC, NCC, ADHD-C

Provider Business Mailing Address
First Line	:	1328 JENKS ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5117
Country	:	US
Telephone Number	:	810-334-8895
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 JENKS ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-5117
Country	:	US
Telephone Number	:	810-334-8895
Fax Number	:

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

Provider Enumeration Date	:	06/02/2021
Last Update Date	:	06/02/2024

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