| Timothy J Daheim Pa | |
|
2407 S Clear Creek Rd Killeen TX 76549-5721 | |
| (254) 773-0764 | |
| (254) 935-2258 |
| Full Name | Timothy J Daheim Pa |
|---|---|
| Speciality | Psychologist |
| Location | 2407 S Clear Creek Rd, Killeen, Texas |
| Authorized Official Name and Position | Timothy J Daheim (OWNER) |
| Authorized Official Contact | 2547730764 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Timothy J Daheim Pa Po Box 204 Temple TX 76503-0204 Ph: (254) 773-0764 | Timothy J Daheim Pa 2407 S Clear Creek Rd Killeen TX 76549-5721 Ph: (254) 773-0764 |
| NPI Number | 1376973321 |
|---|---|
| Provider Enumeration Date | 11/12/2013 |
| Last Update Date | 02/14/2017 |
| Medicare PECOS PAC ID | 6204063688 |
|---|---|
| Medicare Enrollment ID | O20131210000686 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376973321 | NPI | - | NPPES |
| 347534501 | Medicaid | TX | |
| 140806403 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 31399 (Texas) | Secondary |
| 103TC0700X | Psychologist - Clinical | 31399 (Texas) | Primary |
| Provider Name | Timothy J Daheim |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437176955 PECOS PAC ID: 2466689849 Enrollment ID: I20131210000767 |
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