Provider Demographics
NPI:1699171389
Name:IBUTU, TIMOTHY MURUNGI (LCPC, NCC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MURUNGI
Last Name:IBUTU
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:MURUNGI
Other - Last Name:IBUTU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LC4519
Mailing Address - Street 1:208 INGLESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4420
Mailing Address - Country:US
Mailing Address - Phone:443-739-8170
Mailing Address - Fax:
Practice Address - Street 1:4201 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3305
Practice Address - Country:US
Practice Address - Phone:410-764-8560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4519101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health