Tim Enevoldsen M.Ed., LPC-S, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

10727 Issued in TX

Legal business name

TIM ENEVOLDSEN M.ED., LPC-S, PLLC

Practice address

6666 W Amarillo Blvd
Suite 4
Amarillo, TX 79106-1756

Phone

(806) 570-3775

Fax

(806) 358-3627

NPI assigned

Oct 7, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Timothy John Enevoldsen, M.ED.,LPCS,LMFT,LCDCNPI 1851404206

Title

Therapist

Phone

(806) 570-3775

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy John Enevoldsen, M.ED., LPC, LMFT

  • Professional Counselor
  • Amarillo, TX
  • NPI 1851404206
  NPD (past) Authorized official

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

{
    "created_epoch": "1475798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475798400000",
    "number": "1184174609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6666 W AMARILLO BLVD",
            "address_2": "SUITE 4",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061756",
            "telephone_number": "806-570-3775",
            "fax_number": "806-358-3627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6666 W AMARILLO BLVD",
            "address_2": "SUITE 4",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061756",
            "telephone_number": "806-570-3775",
            "fax_number": "806-358-3627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIM ENEVOLDSEN M.ED., LPC-S, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-07",
        "last_updated": "2016-10-07",
        "status": "A",
        "authorized_official_last_name": "ENEVOLDSEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "806-570-3775",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.ED.,LPCS,LMFT,LCDC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "10727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "095362205",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Tidwell
• Lisa C Tidwell, LCSW
• Stephen Tidwell, D.O.
• Alyssa Marie Tienda, MD
• Reva Tilley, LPC
• Troy Don Timmons, M.ED., L.P.C.
• Andrew Chase Timms, PHARMD.
• Timothy M Risko, MD, PA
• Tina Spohn-Ledford Family Practice Clinic
• Duane Rosby Tinkler, DDS, MSD

• Professional Counselor in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.