Provider Demographics
NPI:1326388554
Name:ROYER, TIMOTHY GRAYSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GRAYSON
Last Name:ROYER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49468-0607
Mailing Address - Country:US
Mailing Address - Phone:800-600-4096
Mailing Address - Fax:800-606-8839
Practice Address - Street 1:3790 30TH ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1602
Practice Address - Country:US
Practice Address - Phone:800-600-4096
Practice Address - Fax:800-606-8839
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009353103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1013294628OtherCOMPANY/GROUP NPI #
MI0D14689OtherBLUE CROSS BLUE SHIELD OF MICHIGAN