Provider Demographics
NPI:1003103482
Name:DREBY, TIMOTHY CLYDE (MFT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:CLYDE
Last Name:DREBY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:C
Other - Last Name:DREBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:7306 GLADYS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-2237
Mailing Address - Country:US
Mailing Address - Phone:510-735-1358
Mailing Address - Fax:
Practice Address - Street 1:1211 EMBARCADERO
Practice Address - Street 2:SUITE 300
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5119
Practice Address - Country:US
Practice Address - Phone:510-535-1409
Practice Address - Fax:510-535-1414
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45563106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist