Provider Demographics
NPI:1346540556
Name:THEYE, TIMOTHY (LCSW, LMHC, LCAC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:THEYE
Suffix:
Gender:M
Credentials:LCSW, LMHC, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 LAKE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5439
Mailing Address - Country:US
Mailing Address - Phone:260-450-6068
Mailing Address - Fax:260-422-4309
Practice Address - Street 1:2314 LAKE AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5439
Practice Address - Country:US
Practice Address - Phone:260-450-6068
Practice Address - Fax:260-422-4309
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004130A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical