Provider Demographics
NPI:1962865907
Name:DENNIS, TIMOTHY C (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 1ST ST.
Mailing Address - Street 2:NICASA
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035
Mailing Address - Country:US
Mailing Address - Phone:847-433-1303
Mailing Address - Fax:847-433-2324
Practice Address - Street 1:1724 1ST ST.
Practice Address - Street 2:NICASA
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035
Practice Address - Country:US
Practice Address - Phone:847-433-1303
Practice Address - Fax:847-433-2324
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)