Provider Demographics
NPI:1306843586
Name:MCGUIRE, TIMOTHY EDWARD (LICSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:LICSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 COUNTY ROAD B W
Mailing Address - Street 2:SUITE 200 SOUTH
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4057
Mailing Address - Country:US
Mailing Address - Phone:651-635-0477
Mailing Address - Fax:651-635-0454
Practice Address - Street 1:1711 COUNTY ROAD B W
Practice Address - Street 2:SUITE 200 SOUTH
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4057
Practice Address - Country:US
Practice Address - Phone:651-635-0477
Practice Address - Fax:651-635-0454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN068MOMCOtherBLUE CROSS BLUE SHIELD
MN068MOMCOtherBLUE CROSS BLUE SHIELD