NPIMap

Timothy Haines, LPC

Individual provider Active NPI Mental Health Counselor · Mesa, AZ

NPI 1497813638 · NPPES record last updated Apr 6, 2023

Key facts

NPI
1497813638
Entity type
Individual (NPI type 1)
Primary specialty
Mental Health Counselor 101YM0800X
License
LPC-1661 (AZ)
Practice address
10032 E Southern Ave
Mesa, AZ 85209-2759
Phone
(480) 351-2850
NPI assigned
Dec 4, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 17

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

Medicare Care Compare profile

Specialty
Mental Health Counselor
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sun Life Family Health Center Inc (46 clinicians)

Practice addresses (Care Compare)

10032 E Southern Ave
Mesa, AZ 85209-2759
Phone (480) 351-2850

174 W Hwy 287
Florence, AZ 85132-8170
Phone (520) 868-5811

5618 E Athena Rd
Florence, AZ 85132-5589

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20240102000946 AZ Practitioner - Mental Health Counselor 2668822784 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
LPC-1661AZMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sun Life Family Health Center, Inc. Current Accepting new patients
Sun Life Family Health Center, Inc. Current Accepting new patients
Sun Life Family Health Center, Inc. Current
since Jan 1, 2024		 Accepting new patients
Sun Life Family Health Center, Inc. Current
since Jan 1, 2024		 Accepting new patients
Sun Life Family Health Center, Inc. Current Accepting new patients
Horizon Health & Wellness, Inc. Past Accepting new patients
Horizon Health and Wellness, Inc. Past Accepting new patients
Horizon Health & Wellness, Inc. Mental Health Past Accepting new patients
Horizon Health and Wellness, Inc. Past Accepting new patients

Locations

1856 E Florence Blvd
Casa Grande, AZ 85122
Phone (520) 381-0380

865 N Arizola Rd
Casa Grande, AZ 85122
Phone (520) 381-0363

655 S Dobson Rd
Ste 201
Chandler, AZ 85224
Phone (480) 307-9471

205 N Stuart Blvd
Eloy, AZ 85131
Phone (520) 466-7883

174 W Highway 287
Florence, AZ 85132
Phone (520) 868-5811

10032 E Southern Ave
Mesa, AZ 85209
Phone (480) 339-2853

23 S McNab Pkwy
San Manuel, AZ 85631
Phone (520) 385-2234

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LPC-1661 AZ Yes

Addresses

Primary practice location

10032 E Southern Ave
Mesa, AZ 85209-2759

Mailing address

PO Box 10097
Casa Grande, AZ 85130-0020
Phone (520) 836-3446

Other practice location 1

1100 N Broad St
Globe, AZ 85501-2757
Phone (928) 402-9297

Other identifiers

IdentifierTypeStateIssuer
779720MedicaidAZ

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 6, 2023.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1497813638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10097",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851300020",
            "telephone_number": "520-836-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10032 E SOUTHERN AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852092759",
            "telephone_number": "480-351-2850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Globe",
            "state": "AZ",
            "postal_code": "855012757",
            "country_code": "US",
            "telephone_number": "928-402-9297",
            "fax_number": "928-402-9414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HAINES",
        "first_name": "TIMOTHY",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LPC-1661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "779720",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

All providers in Mesa, AZ · Mental Health Counselor in Arizona

Sources for this page

Verify at the official NPI Registry.