| Tim Enevoldsen M.ed., Lpc-s, Pllc | |
|
6666 W Amarillo Blvd Suite 4 Amarillo TX 79106-1756 | |
| (806) 570-3775 | |
| (806) 358-3627 |
| Full Name | Tim Enevoldsen M.ed., Lpc-s, Pllc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6666 W Amarillo Blvd, Amarillo, Texas |
| Authorized Official Name and Position | Timothy John Enevoldsen (THERAPIST) |
| Authorized Official Contact | 8065703775 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tim Enevoldsen M.ed., Lpc-s, Pllc 6666 W Amarillo Blvd Suite 4 Amarillo TX 79106-1756 Ph: (806) 570-3775 | Tim Enevoldsen M.ed., Lpc-s, Pllc 6666 W Amarillo Blvd Suite 4 Amarillo TX 79106-1756 Ph: (806) 570-3775 |
| NPI Number | 1184174609 |
|---|---|
| Provider Enumeration Date | 10/07/2016 |
| Last Update Date | 10/07/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184174609 | NPI | - | NPPES |
| 095362205 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 10727 (Texas) | Primary |
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