Provider Demographics
NPI:1649700550
Name:ANDERSON, TIMOTHY (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:1 OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Mailing Address - Street 2:ROOM 002 ATHENS, OH 45701-2942 UNITED STATES
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2942
Mailing Address - Country:US
Mailing Address - Phone:740-593-0902
Mailing Address - Fax:740-593-4790
Practice Address - Street 1:1 OHIO UNIVERSITY PSYCHOLOGY AND SOCIAL WORK CLINIC
Practice Address - Street 2:ROOM 002 ATHENS, OH 45701-2942 UNITED STATES
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2942
Practice Address - Country:US
Practice Address - Phone:740-593-0902
Practice Address - Fax:740-593-4790
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH5117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103TC0700XOtherCLINICAL PSYCHOLOGIST