Provider Demographics
NPI:1750443396
Name:POPANZ, TIMOTHY JON (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:POPANZ
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 1:818 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4410
Mailing Address - Country:US
Mailing Address - Phone:206-329-5255
Mailing Address - Fax:206-726-1878
Practice Address - Street 1:818 12TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4410
Practice Address - Country:US
Practice Address - Phone:206-329-5255
Practice Address - Fax:206-726-1878
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7085475Medicaid
WA7085475Medicaid