Healthcare Provider Details

I. General information

NPI: 1427487628
Provider Name (Legal Business Name): TIMOTHY PAVLATOS M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 SE LAKE RD SUITE 202
MILWAUKIE OR
97267-2148
US

IV. Provider business mailing address

6902 SE LAKE RD SUITE 202
MILWAUKIE OR
97267-2148
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-2810
  • Fax: 503-652-8553
Mailing address:
  • Phone: 503-652-2810
  • Fax: 503-652-8553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberT0907
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: