Provider Demographics
NPI:1043487234
Name:ERVIN, TIM R (LCPC)
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:R
Last Name:ERVIN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WILKE RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1534
Mailing Address - Country:US
Mailing Address - Phone:224-520-0611
Mailing Address - Fax:
Practice Address - Street 1:125 S WILKE RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1534
Practice Address - Country:US
Practice Address - Phone:224-520-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health