Provider Demographics
NPI:1457248254
Name:JOACHIM, TIMOTHY PAUL
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PAUL
Last Name:JOACHIM
Suffix:
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 1:16430 SE MARNA RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8846
Mailing Address - Country:US
Mailing Address - Phone:503-770-0083
Mailing Address - Fax:
Practice Address - Street 1:39065 PIONEER BLVD STE 104
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-8088
Practice Address - Country:US
Practice Address - Phone:503-770-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR11264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health