Provider Demographics
NPI:1942022132
Name:FELEGY, TIMOTHY (LADC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:FELEGY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 MUSKIE BAY RD NE
Mailing Address - Street 2:
Mailing Address - City:LONGVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56655-3313
Mailing Address - Country:US
Mailing Address - Phone:651-214-1494
Mailing Address - Fax:
Practice Address - Street 1:823 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3770
Practice Address - Country:US
Practice Address - Phone:218-454-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306340101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)