MEDICARE: TIMOTHY JOHN TORMEY PSYD LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC36339	CA

General Provider Information

NPI Number	:	1578639860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY JOHN TORMEY PSYD LMFT

Provider Business Mailing Address
First Line	:	3707 THIRD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103
Country	:	US
Telephone Number	:	619-244-3575
Fax Number	:	619-542-0324

Provider Business Practice Location Address
First Line	:	137 N COTTONWOOD ST STE 2500
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95695-6664
Country	:	US
Telephone Number	:	530-312-4928
Fax Number	:	530-666-8294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/14/2023

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