Provider Demographics
NPI:1619371549
Name:TIMOTHY J HOWARD ASSOCIATES, LLC
Entity Type:Organization
Organization Name:TIMOTHY J HOWARD ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-254-6678
Mailing Address - Street 1:1591 W CENTRE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6314
Mailing Address - Country:US
Mailing Address - Phone:269-254-6678
Mailing Address - Fax:269-585-6152
Practice Address - Street 1:1591 W CENTRE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6314
Practice Address - Country:US
Practice Address - Phone:269-254-6678
Practice Address - Fax:269-585-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-21
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION92670-006Medicare PIN