Provider Demographics
NPI:1679762264
Name:SIGAFOOS, TIMOTHY ALAN
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:SIGAFOOS
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 1:851 E VIA CARMELITOS
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-6519
Mailing Address - Country:US
Mailing Address - Phone:562-423-5471
Mailing Address - Fax:
Practice Address - Street 1:851 E VIA CARMELITOS
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6519
Practice Address - Country:US
Practice Address - Phone:562-423-5471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF53980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist