Provider Demographics
NPI:1699967109
Name:STARKS, TIMOTHY S (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:S
Last Name:STARKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5007
Mailing Address - Country:US
Mailing Address - Phone:701-858-0115
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:525 31ST AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7036
Practice Address - Country:US
Practice Address - Phone:701-500-5430
Practice Address - Fax:701-355-6800
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND74088Medicaid