Individual provider Active NPI

Timothy L. Mills, PSY.D.

  • Clinical Psychologist
  • Muskegon, MI
National Provider Identifier
1053642660
Registry record updated Jan 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301011910 Issued in MI
Practice address
5353 Grand Haven Rd
Suite B
Muskegon, MI 49441-5985
Phone
(231) 799-8182
Fax
(231) 799-8183
NPI assigned
Jan 21, 2010
Last updated
Jan 21, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301011910 MI Primary

Addresses

Primary practice location

5353 Grand Haven Rd
Suite B
Muskegon, MI 49441-5985

Mailing address

446 W 40TH St
Holland, MI 49423-4644
Phone (616) 395-3123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160321001535 MI Practitioner - Clinical Psychologist 1557668480 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holland Family Counseling LLCGroup PAC ID 6406182872, 4 clinicians

Practice addresses (Care Compare)

490 Century LN
Suite 200
Holland, MI 49423-2220
Phone (616) 594-0810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Holland Family Counseling LLC CurrentSince May 15, 2019 Accepting new patients
Kristine Koetje Ma, PC CurrentSince Feb 15, 2016 Accepting new patients
Kristine Koetje Ma, PC Clinical Past Accepting new patients
New Direction Counseling Center Clinical Past Accepting new patients

Locations

490 Century Ln
Ste 200
Holland, MI 49423
Phone (616) 366-6947

5353 Grand Haven Rd
Ste B
Norton Shores, MI 49441
Phone (231) 215-9684

17224 Van Wagoner Rd
Spring Lake, MI 49456
Phone (616) 296-2130

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264032000000",
    "number": "1053642660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "446 W 40TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234644",
            "telephone_number": "616-395-3123",
            "fax_number": "616-395-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 GRAND HAVEN RD",
            "address_2": "SUITE B",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494415985",
            "telephone_number": "231-799-8182",
            "fax_number": "231-799-8183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLS",
        "first_name": "TIMOTHY",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-21",
        "last_updated": "2010-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301011910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

Verify at the official NPI Registry.