Healthcare Provider Details

I. General information

NPI: 1992929053
Provider Name (Legal Business Name): TIMMOND K. MCMANUS CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

811 MADISON ST
EVERETT WA
98203-4543
US

V. Phone/Fax

Practice location:
  • Phone: 254-212-4200
  • Fax:
Mailing address:
  • Phone: 254-212-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number164X00000X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: