Provider Demographics
NPI:1518425826
Name:GRZESKIEWICZ, TIMOTHY JAMES (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:GRZESKIEWICZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47932-1627
Mailing Address - Country:US
Mailing Address - Phone:765-585-5060
Mailing Address - Fax:
Practice Address - Street 1:1104 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1627
Practice Address - Country:US
Practice Address - Phone:765-585-5060
Practice Address - Fax:765-299-0049
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)