Provider Demographics
NPI:1417664798
Name:MOUW, TIMOTHY ALLAN (PHD, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLAN
Last Name:MOUW
Suffix:
Gender:M
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79118-3721
Mailing Address - Country:US
Mailing Address - Phone:806-318-8863
Mailing Address - Fax:
Practice Address - Street 1:301 S POLK ST STE 525
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1439
Practice Address - Country:US
Practice Address - Phone:806-318-8863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional