Provider Demographics
NPI:1689432163
Name:WEST, TIMOTHY KEVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KEVIN
Last Name:WEST
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 1:512 MALOBAR DR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1527
Mailing Address - Country:US
Mailing Address - Phone:415-302-5912
Mailing Address - Fax:
Practice Address - Street 1:500 TAMAL PLZ STE 528
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1187
Practice Address - Country:US
Practice Address - Phone:415-892-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist