Provider Demographics
NPI:1285182576
Name:KEATY, TIM JAMES JR
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:JAMES
Last Name:KEATY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4407
Mailing Address - Country:US
Mailing Address - Phone:253-426-8466
Mailing Address - Fax:
Practice Address - Street 1:702 S 14TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4407
Practice Address - Country:US
Practice Address - Phone:253-426-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health