Provider Demographics
NPI:1649335985
Name:ZEDDIES, TIMOTHY JOSEPH (PH, D)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:ZEDDIES
Suffix:
Gender:M
Credentials:PH, D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2804
Mailing Address - Country:US
Mailing Address - Phone:512-495-9556
Mailing Address - Fax:512-495-9774
Practice Address - Street 1:406 W 30TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2804
Practice Address - Country:US
Practice Address - Phone:512-495-9556
Practice Address - Fax:512-495-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018HCOtherBCBS
TX00422PMedicare ID - Type Unspecified