Provider Demographics
NPI:1477522001
Name:TUMLIN, TIMOTHY ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:TUMLIN
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 1:100 TOWER DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5778
Mailing Address - Country:US
Mailing Address - Phone:630-371-1556
Mailing Address - Fax:630-371-1555
Practice Address - Street 1:100 TOWER DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5777
Practice Address - Country:US
Practice Address - Phone:630-371-1556
Practice Address - Fax:630-371-1555
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL422740Medicare ID - Type UnspecifiedPROVIDER NUMBER