Provider Demographics
NPI:1235580119
Name:LAWSON, TIMOTHY (LBA)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LAWSON
Suffix:
Gender:M
Credentials:LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17807 E APOLLO RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-5069
Mailing Address - Country:US
Mailing Address - Phone:509-294-4622
Mailing Address - Fax:
Practice Address - Street 1:17807 E APOLLO RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-5069
Practice Address - Country:US
Practice Address - Phone:509-294-4622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60621291101Y00000X
1-17-26402103K00000X
WABA60781563103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2076796Medicaid
WA2059720Medicaid