Provider Demographics
NPI:1053642660
Name:MILLS, TIMOTHY L (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:L
Last Name:MILLS
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 1:446 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4644
Mailing Address - Country:US
Mailing Address - Phone:616-395-3123
Mailing Address - Fax:616-395-3644
Practice Address - Street 1:5353 GRAND HAVEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-5985
Practice Address - Country:US
Practice Address - Phone:231-799-8182
Practice Address - Fax:231-799-8183
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical