Healthcare Provider Details

I. General information

NPI: 1649101130
Provider Name (Legal Business Name): TIMOTHY WARREN LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 NE 40TH CIR
CAMAS WA
98607-9882
US

IV. Provider business mailing address

810 NE 40TH CIR
CAMAS WA
98607-9882
US

V. Phone/Fax

Practice location:
  • Phone: 360-836-0846
  • Fax:
Mailing address:
  • Phone: 360-836-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.00004739
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: