Provider Demographics
NPI:1376531012
Name:STEIN, TIMOTHY DAVID (MFT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:STEIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4112
Mailing Address - Country:US
Mailing Address - Phone:707-328-3425
Mailing Address - Fax:866-648-8195
Practice Address - Street 1:1023 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4112
Practice Address - Country:US
Practice Address - Phone:707-328-3425
Practice Address - Fax:866-648-8195
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist