Provider Demographics
NPI:1154670735
Name:DAVIS, TIM D (LPC)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6792
Mailing Address - Country:US
Mailing Address - Phone:989-244-1888
Mailing Address - Fax:989-321-6544
Practice Address - Street 1:5816 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6792
Practice Address - Country:US
Practice Address - Phone:989-244-1888
Practice Address - Fax:989-321-6544
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3379101YP2500X
MI6401019625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional