Provider Demographics
NPI:1982002051
Name:SPROWL, TIMOTHY (MA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:SPROWL
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 1:16213 MANSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3630
Mailing Address - Country:US
Mailing Address - Phone:734-812-5878
Mailing Address - Fax:
Practice Address - Street 1:774 AUTUMN RIDGE DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-9648
Practice Address - Country:US
Practice Address - Phone:734-812-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006066103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist