Provider Demographics
NPI:1245506146
Name:PRIOR, TIMOTHY MICHAEL (MS LMFT, BCBA)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:PRIOR
Suffix:
Gender:M
Credentials:MS LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 S BREA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5312
Mailing Address - Country:US
Mailing Address - Phone:562-972-4846
Mailing Address - Fax:
Practice Address - Street 1:770 S BREA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5312
Practice Address - Country:US
Practice Address - Phone:562-972-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC50968106H00000X
1-06-3068103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst