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NPI Code Detail

MEDICARE: DOMINIQUE TIMOTHEE

MEDICARE: DOMINIQUE TIMOTHEE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor91230TX

General Provider Information

NPI Number : 1306381363
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE TIMOTHEE
Provider Business Mailing Address
First Line : 20333 STATE HIGHWAY 249 STE 200
Second Line :
City : HOUSTON
State : TX
Zip : 77070-2613
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20333 STATE HIGHWAY 249 STE 200
Second Line :
City : HOUSTON
State : TX
Zip : 77070-2613
Country : US
Telephone Number : 503-922-3360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2016
Last Update Date : 12/29/2023

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Directions to “ DOMINIQUE TIMOTHEE ” Practice Location

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