Healthcare Provider Details

I. General information

NPI: 1184949786
Provider Name (Legal Business Name): TIMOTEO DARIO YEPES LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIMOTHY DARIO YEPES LICSW

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 GOLF CLUB RD SE STE 101
LACEY WA
98503-2302
US

IV. Provider business mailing address

430 SE GOSNELL LN
SHELTON WA
98584-8384
US

V. Phone/Fax

Practice location:
  • Phone: 206-679-0531
  • Fax:
Mailing address:
  • Phone: 206-679-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60022341
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: