Provider Demographics
NPI:1568194330
Name:BENNETT, TIMOTHY ASLAN (LLMSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ASLAN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:AZLANI
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6578 BROOKHILLS CT SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7282
Mailing Address - Country:US
Mailing Address - Phone:616-682-7296
Mailing Address - Fax:
Practice Address - Street 1:26184 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2084
Practice Address - Country:US
Practice Address - Phone:616-682-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511150671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical