Provider Demographics
NPI:1093137945
Name:SUTHERLAND, TIMOTHY OLIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:OLIN
Last Name:SUTHERLAND
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 ESTUARY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1292
Mailing Address - Country:US
Mailing Address - Phone:630-853-5553
Mailing Address - Fax:
Practice Address - Street 1:1509 ESTUARY CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1292
Practice Address - Country:US
Practice Address - Phone:630-853-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166-000-130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist