Provider Demographics
NPI:1487829677
Name:RICE, TIMOTHY A (LADC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:RICE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-9301
Mailing Address - Country:US
Mailing Address - Phone:651-633-4532
Mailing Address - Fax:651-633-9311
Practice Address - Street 1:1405 SILVER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-9301
Practice Address - Country:US
Practice Address - Phone:651-633-4532
Practice Address - Fax:651-633-9311
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)