Healthcare Provider Details

I. General information

NPI: 1134306806
Provider Name (Legal Business Name): TIM ENGLISH MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 GRANT ST
CONCORD CA
94520-2251
US

IV. Provider business mailing address

3800 COOLIDGE AVE
OAKLAND CA
94602-3311
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-4030
  • Fax: 925-687-9658
Mailing address:
  • Phone: 510-482-2244
  • Fax: 510-530-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: