Provider Demographics
NPI:1467528364
Name:WEBER, TIMOTHY TYSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:TYSON
Last Name:WEBER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 224TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-8147
Mailing Address - Country:US
Mailing Address - Phone:206-394-6336
Mailing Address - Fax:
Practice Address - Street 1:9806 SE CARR RD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5813
Practice Address - Country:US
Practice Address - Phone:206-394-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0001173103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist