Provider Demographics
NPI:1922511989
Name:MALONE, TIMOTHY (LMFT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:MALONE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 PLUTO ST
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-8926
Mailing Address - Country:US
Mailing Address - Phone:805-280-6280
Mailing Address - Fax:
Practice Address - Street 1:1411 MARSH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2968
Practice Address - Country:US
Practice Address - Phone:805-931-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA126356OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES