Provider Demographics
NPI:1164807103
Name:MEYER, TIMOTHY (LMSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:MEYER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5404 E H AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1136
Mailing Address - Country:US
Mailing Address - Phone:269-788-3200
Mailing Address - Fax:692-788-3202
Practice Address - Street 1:1651 W CENTRE AVE # 201B
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6312
Practice Address - Country:US
Practice Address - Phone:269-788-3200
Practice Address - Fax:269-788-3202
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010921031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical