Healthcare Provider Details

I. General information

NPI: 1508968637
Provider Name (Legal Business Name): TIMOTHY M OBRIEN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 NE 129TH ST STE 101
VANCOUVER WA
98686-3270
US

IV. Provider business mailing address

2103 NE 129TH ST STE 101
VANCOUVER WA
98686-3270
US

V. Phone/Fax

Practice location:
  • Phone: 360-574-9303
  • Fax: 360-574-9311
Mailing address:
  • Phone: 360-574-9303
  • Fax: 360-574-9311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5984
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60498114
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: