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General NPI Number Information
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NPI Number | 1801176581
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL PATRICK LPC
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Gender | Male
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 718 E SEQUOYAH AVE
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City | VINITA
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State | OK
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Zip | 74301-3326
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Country | US
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Telephone | 918-227-2016
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 209
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City | VINITA
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State | OK
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Zip | 74301-0209
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Country | US
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Telephone | 918-244-1230
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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