MEDICARE: TIMOTHY DAVID HENSON LMSW

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	1041C0700X	Clinical Social Worker	6801095617	MI

General Provider Information

NPI Number	:	1801228051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY DAVID HENSON LMSW

Provider Business Mailing Address
First Line	:	1651 W CENTRE AVE STE 203
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-6313
Country	:	US
Telephone Number	:	269-360-2618
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 W CENTRE AVE STE 203
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-6313
Country	:	US
Telephone Number	:	269-360-2618
Fax Number	:

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

Provider Enumeration Date	:	07/30/2013
Last Update Date	:	05/15/2026

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