Provider Demographics
NPI:1437176955
Name:DAHEIM, TIMOTHY JOSEPH (PHD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:DAHEIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-0204
Mailing Address - Country:US
Mailing Address - Phone:254-415-7989
Mailing Address - Fax:254-699-7309
Practice Address - Street 1:2407 S CLEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-5721
Practice Address - Country:US
Practice Address - Phone:254-415-7989
Practice Address - Fax:254-699-7309
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1408064-03Medicaid
241223OtherTRICARE
241223OtherTRICARE