MEDICARE: TIMOTHYLCSW LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861109027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHYLCSW LLC

Provider Business Mailing Address
First Line	:	7914 E 106TH ST STE 205
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-6802
Country	:	US
Telephone Number	:	918-947-9560
Fax Number	:

Provider Business Practice Location Address
First Line	:	7914 E 106TH ST STE 205
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-6802
Country	:	US
Telephone Number	:	918-947-9560
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	TIMOTHY DEARHAMER
Credential	:	LCSW
Telephone Number	:	918-947-9560

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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Directions to “TIMOTHYLCSW LLC ” Practice Location

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