Provider Demographics
NPI:1174130579
Name:TIMBERLAKE COUNSELING
Entity type:Organization
Organization Name:TIMBERLAKE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:TIMBERLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:816-868-8451
Mailing Address - Street 1:6534 SW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5607
Mailing Address - Country:US
Mailing Address - Phone:816-868-8451
Mailing Address - Fax:
Practice Address - Street 1:6534 SW 24TH CT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-5607
Practice Address - Country:US
Practice Address - Phone:816-868-8451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1265665947Medicaid