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General NPI Number Information
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NPI Number | 1235580119
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Entity Type | Individual
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Provider Name | TIMOTHY LAWSON LBA
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Gender | Male
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 17807 E APOLLO RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99016-5069
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Country | US
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Telephone | 509-294-4622
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Fax |
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Provider Business Mailing Address
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Address Line | 17807 E APOLLO RD
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City | SPOKANE VALLEY
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State | WA
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Zip | 99016-5069
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Country | US
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Telephone | 509-294-4622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CL60621291
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-26402
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA60781563
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License Number State | WA
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