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General NPI Number Information
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NPI Number | 1457248254
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL JOACHIM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 39065 PIONEER BLVD STE 104
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City | SANDY
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State | OR
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Zip | 97055-8088
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Country | US
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Telephone | 503-770-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 16430 SE MARNA RD
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City | DAMASCUS
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State | OR
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Zip | 97089-8846
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Country | US
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Telephone | 503-770-0083
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R11264
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License Number State | OR
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