Provider Demographics
NPI:1760770564
Name:ANDERSON, TIMO EDWARD
Entity Type:Individual
Prefix:MR
First Name:TIMO
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2334
Mailing Address - Country:US
Mailing Address - Phone:734-785-7705
Mailing Address - Fax:734-285-5419
Practice Address - Street 1:15601 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2334
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:734-285-5419
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor