Provider Demographics
NPI:1093901605
Name:WULFF, TIMOTHY JONATHAN I (LMSW, ACSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JONATHAN
Last Name:WULFF
Suffix:I
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 NORTHWIND DR STE 240
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5091
Mailing Address - Country:US
Mailing Address - Phone:517-853-2992
Mailing Address - Fax:517-853-2993
Practice Address - Street 1:4990 NORTHWIND DR STE 240
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5091
Practice Address - Country:US
Practice Address - Phone:517-853-2992
Practice Address - Fax:517-853-2993
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010891691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical