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General NPI Number Information
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NPI Number | 1770044695
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Entity Type | Individual
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Provider Name | TIMOTHY JOSEPH HUMPHREY BCBA
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Gender | Male
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Dates
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Enumeration Date | 03/26/2019
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Last Update Date | 05/15/2024
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Provider Practice Location Address
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Address Line | 21282 BEACH BLVD APT 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5720
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Country | US
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Telephone | 562-476-9282
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Fax |
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Provider Business Mailing Address
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Address Line | 21282 BEACH BLVD APT 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5720
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Country | US
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Telephone | 562-476-9282
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-7291
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License Number State | CA
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