MEDICARE: DR. TIM HILL ED.D, LPC

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	90249	TX

General Provider Information

NPI Number	:	1992416309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIM HILL ED.D, LPC

Provider Business Mailing Address
First Line	:	4448 CORNER BROOK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2732
Country	:	US
Telephone Number	:	402-980-0156
Fax Number	:

Provider Business Practice Location Address
First Line	:	4448 CORNER BROOK LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2732
Country	:	US
Telephone Number	:	402-980-0156
Fax Number	:

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

Provider Enumeration Date	:	12/06/2022
Last Update Date	:	12/06/2022

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