Provider Demographics
NPI:1245248327
Name:HOGAN, TIMOTHY FRANCIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:FRANCIS
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41820 6 MILE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2771
Mailing Address - Country:US
Mailing Address - Phone:248-349-3131
Mailing Address - Fax:248-349-3232
Practice Address - Street 1:41820 6 MILE RD STE 104
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-2771
Practice Address - Country:US
Practice Address - Phone:248-349-3131
Practice Address - Fax:248-349-3232
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009432103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301009432OtherPSYCHOLOGIST