Provider Demographics
NPI:1194029553
Name:PLANT, TIMOTHY DANIEL
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:PLANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:D
Other - Last Name:PLANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2586 7TH AVE E
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3083
Mailing Address - Country:US
Mailing Address - Phone:651-633-7300
Mailing Address - Fax:651-633-7301
Practice Address - Street 1:2586 7TH AVE E
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3083
Practice Address - Country:US
Practice Address - Phone:651-633-7300
Practice Address - Fax:651-633-7301
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN136061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical