Provider Demographics
NPI:1336410414
Name:WESTFELDT, TIMOTHY VICTOR (MS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:VICTOR
Last Name:WESTFELDT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N PACIFIC HWY
Mailing Address - Street 2:APT 44
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-9509
Mailing Address - Country:US
Mailing Address - Phone:541-535-6931
Mailing Address - Fax:
Practice Address - Street 1:100 N PACIFIC HWY
Practice Address - Street 2:APT 44
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-9509
Practice Address - Country:US
Practice Address - Phone:541-535-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health