Provider Demographics
NPI:1528410974
Name:SERRANO, TIMOTHY
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP
Mailing Address - Street 1:1801 N LAURENT ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5459
Mailing Address - Country:US
Mailing Address - Phone:361-894-8734
Mailing Address - Fax:361-894-8735
Practice Address - Street 1:1801 N LAURENT ST
Practice Address - Street 2:SUITE 107
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5459
Practice Address - Country:US
Practice Address - Phone:361-894-8734
Practice Address - Fax:361-894-8735
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst