MEDICARE: MR. TIMOTHY JOSEPH ZOEBELEIN LCSW

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	101YM0800X	Mental Health Counselor	1723	OR

General Provider Information

NPI Number	:	1780865568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY JOSEPH ZOEBELEIN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 855
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-0855
Country	:	US
Telephone Number	:	503-357-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 ELM ST
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2503
Country	:	US
Telephone Number	:	503-357-8793
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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