Provider Demographics
NPI:1033633813
Name:IRMEN, TIMOTHY STEVEN (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STEVEN
Last Name:IRMEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710C FOOTHILLS DR. SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132
Mailing Address - Country:US
Mailing Address - Phone:503-930-2923
Mailing Address - Fax:503-523-2193
Practice Address - Street 1:710 E FOOTHILLS DR STE 104C
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-6125
Practice Address - Country:US
Practice Address - Phone:503-930-2923
Practice Address - Fax:503-523-2193
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL38781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL3878OtherOREGON BOARD OF SOCIAL WORK