Provider Demographics
NPI:1558496943
Name:VANDER MOLEN, TIM L (PHD, LLP)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:L
Last Name:VANDER MOLEN
Suffix:
Gender:M
Credentials:PHD, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 CENTER STREET
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906
Mailing Address - Country:US
Mailing Address - Phone:517-853-1925
Mailing Address - Fax:517-853-1926
Practice Address - Street 1:809 CENTER STREET
Practice Address - Street 2:SUITE 8A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-5257
Practice Address - Country:US
Practice Address - Phone:517-853-1925
Practice Address - Fax:517-853-1926
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6301006675103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical