Provider Demographics
NPI:1114717931
Name:TIM BAYNES, LCSW PLLC
Entity type:Organization
Organization Name:TIM BAYNES, LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAYNES
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-828-1678
Mailing Address - Street 1:13554 S KALAMAZOO CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7048
Mailing Address - Country:US
Mailing Address - Phone:847-828-1678
Mailing Address - Fax:
Practice Address - Street 1:13554 S KALAMAZOO CT
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7048
Practice Address - Country:US
Practice Address - Phone:847-828-1678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty