Provider Demographics
NPI:1780865568
Name:ZOEBELEIN, TIMOTHY JOSEPH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:ZOEBELEIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-0855
Mailing Address - Country:US
Mailing Address - Phone:503-357-8793
Mailing Address - Fax:
Practice Address - Street 1:1609 ELM ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2503
Practice Address - Country:US
Practice Address - Phone:503-357-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health