Provider Demographics
NPI:1255532503
Name:COY, TIMOTHY (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:COY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 112TH AVE SE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6901
Mailing Address - Country:US
Mailing Address - Phone:425-467-6252
Mailing Address - Fax:
Practice Address - Street 1:1400 112TH AVE SE
Practice Address - Street 2:SUITE 205
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6901
Practice Address - Country:US
Practice Address - Phone:425-467-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002379103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical