Provider Demographics
NPI:1295043362
Name:HART, TIM (LICSW)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:HART
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 7TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2518
Mailing Address - Country:US
Mailing Address - Phone:701-320-7005
Mailing Address - Fax:
Practice Address - Street 1:520 3RD ST NW
Practice Address - Street 2:BOX 2055
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2968
Practice Address - Country:US
Practice Address - Phone:701-253-6300
Practice Address - Fax:701-253-6400
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND41481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical