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NPI Code Detail

MEDICARE: TIMOTHY LARGE

MEDICARE: TIMOTHY LARGE
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
1101Y00000XCounselorWA

General Provider Information

NPI Number : 1508704313
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY LARGE
Provider Business Mailing Address
First Line : 4810 S JUNEAU ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-2848
Country : US
Telephone Number : 206-858-0824
Fax Number :
Provider Business Practice Location Address
First Line : 2212 S JACKSON ST
Second Line :
City : SEATTLE
State : WA
Zip : 98144-2591
Country : US
Telephone Number : 206-322-2387
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ TIMOTHY LARGE ” Practice Location

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