Provider Demographics
NPI:1669672721
Name:DAVIS, TIMOTHY ANDREW (LISW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 87TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98205-1500
Mailing Address - Country:US
Mailing Address - Phone:425-335-5285
Mailing Address - Fax:
Practice Address - Street 1:208 87TH AVE SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98205-1500
Practice Address - Country:US
Practice Address - Phone:425-335-5285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000041631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical