Provider Demographics
NPI:1437597689
Name:TIMMERMANS, DANA LANE (MFT)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:LANE
Last Name:TIMMERMANS
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 1:29112 MIRA VIS
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-4325
Mailing Address - Country:US
Mailing Address - Phone:949-680-7793
Mailing Address - Fax:
Practice Address - Street 1:29112 MIRA VIS
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4325
Practice Address - Country:US
Practice Address - Phone:949-680-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherTAXOMOMY