Active NPI
Timothy Samuel Prevost, M.S.W.
- Social Worker
- Clinton Township, MI
National Provider Identifier
1174764054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6802080110
- Practice address
- 16200 19 Mile Rd
Clinton Township, MI 48038-1103 - Phone
- (586) 263-8669
- Fax
- (586) 263-8669
- NPI assigned
- Mar 23, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6802080110 | MI | Primary |
Addresses
Primary practice location
16200 19 Mile Rd
Clinton Township, MI 48038-1103
Mailing address
22064 Elmwood Ave
Eastpointe, MI 48021-2114
Phone (586) 808-8957
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6802080110 | MI | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1237766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1237766400000",
"number": "1174764054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22064 ELMWOOD AVE",
"city": "EASTPOINTE",
"state": "MI",
"postal_code": "480212114",
"telephone_number": "586-808-8957"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16200 19 MILE RD",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480381103",
"telephone_number": "586-263-8669",
"fax_number": "586-263-8669"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PREVOST",
"first_name": "TIMOTHY",
"middle_name": "SAMUEL",
"name_prefix": "Mr.",
"credential": "M.S.W.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-23",
"last_updated": "2009-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6802080110",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
- Preferred Counseling Professionals LLC
- Premier Pharmacy LLC
- Premium Care Pharmacy LLC
- Christopher Paul Press, DDS
- Prestigious Transportation
- Cynthia Ann Prieur, D.D.S.
- Robert G. Prieur, D.D.S.
- Christian Ozzy Prima, BEHAVIOR TECHNICIAN
- Priority Professional Counseling Associates
- Stephanie Priskorn, LLPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.