Provider Demographics
NPI:1669142618
Name:FREEMAN, TIMOTHY KIMBLE (MHP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KIMBLE
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5857 XERXES AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2818
Mailing Address - Country:US
Mailing Address - Phone:612-703-6320
Mailing Address - Fax:
Practice Address - Street 1:6533 FLYING CLOUD DR STE 200
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3335
Practice Address - Country:US
Practice Address - Phone:612-703-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health