Provider Demographics
NPI:1003967316
Name:SPRUILL, TIMOTHY EUGENE (EDD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:SPRUILL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12825 WATERHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8637
Mailing Address - Country:US
Mailing Address - Phone:407-760-9026
Mailing Address - Fax:407-303-8659
Practice Address - Street 1:7975 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8204
Practice Address - Country:US
Practice Address - Phone:407-303-6830
Practice Address - Fax:407-303-8659
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist