Provider Demographics
NPI:1659035350
Name:TIM BIZELLI COUNSELING LLC
Entity Type:Organization
Organization Name:TIM BIZELLI COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:BIZELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-345-1106
Mailing Address - Street 1:230 GOBBLER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2578
Mailing Address - Country:US
Mailing Address - Phone:636-345-1106
Mailing Address - Fax:636-356-1319
Practice Address - Street 1:8759 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7538
Practice Address - Country:US
Practice Address - Phone:636-345-1106
Practice Address - Fax:636-356-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)