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

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

10727 Issued in TX

Practice address

6666 W Amarillo Blvd
Suite 28
Amarillo, TX 79106-1756

Phone

(806) 570-3775

Fax

(806) 356-8189

NPI assigned

Aug 17, 2006

Last updated

Jun 17, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

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.

• Tim Enevoldsen M.Ed., LPC-S, PLLC

  • Professional Counselor
  • Amarillo, TX
  • NPI 1184174609
  Authorized official Same address or phone

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213660800000",
    "number": "1851404206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50291",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791590291",
            "telephone_number": "806-570-3775",
            "fax_number": "806-356-8189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6666 W AMARILLO BLVD",
            "address_2": "SUITE 28",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061756",
            "telephone_number": "806-570-3775",
            "fax_number": "806-356-8189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENEVOLDSEN",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "M.ED., LPC, LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2008-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "10727",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "003822-042155",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "095362201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emeritus Corporation (Brookdale Medi Park West)
• Terry Emerson, NP
• Empowerme Rehabilitation, LLC
• Richard Steven Enchelmeyer, PHARMD
• Encompass Health Rehabilitation Hospital of Amarillo, LLC (Rehabilitation Hospital of Amarillo)
• Cristiane Campos Ennis, M.D.
• Enos Dermatopathology PLLC
• Tyler Enos, MD
• Epic Health Services, Inc. (Aveanna Healthcare)
• Epic Health Services, Inc. (Aveanna Healthcare)

• 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 Jun 17, 2008; 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.