| Doctor Name: | MR. TIMOTHY CHARLES ROSENBOOM |
| NPI Number: | 1861560195 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M. DIV. |
| License Number: | 140001 |
| Business Practice Address: | 960 E State St Cassopolis, MI - 490319339 |
| Business Phone Number: | 2694769781 |
| Business Fax Number: | 2694769783 |
| Mailing Address: | 8848 Kephart Ln, BERRIEN SPRINGS |
| State: | MI |
| Postal Code: | 491031440 |
| Phone Number: | 2694711955 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 140001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |