Provider Demographics
NPI:1184949786
Name:YEPES, TIMOTEO DARIO (LICSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTEO
Middle Name:DARIO
Last Name:YEPES
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:MR
Other - First Name:TIMOTHY
Other - Middle Name:DARIO
Other - Last Name:YEPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:430 SE GOSNELL LN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-8384
Mailing Address - Country:US
Mailing Address - Phone:206-679-0531
Mailing Address - Fax:
Practice Address - Street 1:1110 GOLF CLUB RD SE STE 101
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-2302
Practice Address - Country:US
Practice Address - Phone:206-679-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 600223411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical