Provider Demographics
NPI:1134896830
Name:TIMOKHIN, OLEG YURIEVICH (MFT-IT)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:YURIEVICH
Last Name:TIMOKHIN
Suffix:
Gender:M
Credentials:MFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 ANNIVERSARY LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3257
Mailing Address - Country:US
Mailing Address - Phone:608-835-5050
Mailing Address - Fax:608-835-5010
Practice Address - Street 1:165 W NETHERWOOD ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1107
Practice Address - Country:US
Practice Address - Phone:608-835-5050
Practice Address - Fax:608-835-5010
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
WI803228106H00000X
WIPENDING106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist