Provider Demographics
NPI:1508968637
Name:OBRIEN, TIMOTHY M (LMHC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:OBRIEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 NE 129TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3270
Mailing Address - Country:US
Mailing Address - Phone:360-574-9303
Mailing Address - Fax:360-574-9311
Practice Address - Street 1:2103 NE 129TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3270
Practice Address - Country:US
Practice Address - Phone:360-574-9303
Practice Address - Fax:360-574-9311
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5984101YM0800X
WALH60498114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health