MEDICARE: TIMOTHY COLLISTER PHD & ASSOCIATES, INC

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
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY12895	CA
2	103TF0000X	Family Psychologist	PSY12895	CA
3	103T00000X	Psychologist	PSY12985	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407912462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY COLLISTER PHD & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1441 HUNTINGTON DR
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4512
Country	:	US
Telephone Number	:	323-588-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	7024 SEVILLE AVE STE D
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4969
Country	:	US
Telephone Number	:	323-588-9600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY D COLLISTER
Credential	:	PHD
Telephone Number	:	323-588-9600

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/27/2007

Similar Medicare Providers

1578795803 — PACIFIC COAST RX LLC
Practice Location Address:

7024 SEVILLE AVE STE E
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-587-1200
Practice Fax: 323-587-1300

1679648984 — DR. COLLISTER AND ASSOCIATES
Practice Location Address:

7024 SEVILLE AVE , STE D
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-588-9600
Practice Fax:

1083780548 — MELISSA GARCIA MA
Practice Location Address:

7024 SEVILLE AVE
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-588-9600
Practice Fax:

1932224987 — TIMOTHY COLLISTER PHD, INC.
Practice Location Address:

7024 SEVILLE AVE STE D
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-588-9600
Practice Fax: 323-588-9696

1508092651 — MRS. ROSA MARGARITA ORTIZ FEBLES MA, MFTI
Practice Location Address:

7024 SEVILLE AVE STE D
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-588-9600
Practice Fax: 323-588-9696

1508446204 — MARY JOAN KRISTINE R DIAZ PHARMD
Practice Location Address:

7024 SEVILLE AVE STE E
HUNTINGTON PARK, CA
90255-4969

Practice Phone: 323-587-1200
Practice Fax: 323-587-1300

Directions to “TIMOTHY COLLISTER PHD & ASSOCIATES, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.