Provider Demographics
NPI:1487618070
Name:CEFAI, TIMOTHY RICHARD (FLP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:CEFAI
Suffix:
Gender:M
Credentials:FLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 OKEMOS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2822
Mailing Address - Country:US
Mailing Address - Phone:517-333-4858
Mailing Address - Fax:517-999-3187
Practice Address - Street 1:812 E JOLLY RD
Practice Address - Street 2:SUITE 111
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6818
Practice Address - Country:US
Practice Address - Phone:517-346-8200
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36233008Medicare ID - Type UnspecifiedMEDICARE