MEDICARE: TIMOTHY MARQUIS HARVEY

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor		CA

General Provider Information

NPI Number	:	1801398979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY MARQUIS HARVEY

Provider Business Mailing Address
First Line	:	770 47TH ST APT B
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1807
Country	:	US
Telephone Number	:	510-619-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	770 47TH ST APT B
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1807
Country	:	US
Telephone Number	:	510-619-4954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	03/05/2018

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Directions to “ TIMOTHY MARQUIS HARVEY ” Practice Location

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