Provider Demographics
NPI:1396721247
Name:HOWARD, TIMOTHY JAMES (EDD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:HOWARD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 EDGEMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2343
Mailing Address - Country:US
Mailing Address - Phone:269-321-8564
Mailing Address - Fax:269-321-8641
Practice Address - Street 1:1662 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4410
Practice Address - Country:US
Practice Address - Phone:269-321-8564
Practice Address - Fax:269-321-8641
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010009061103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M42940Medicare PIN