Provider Demographics
NPI:1720101850
Name:PROCTOR, TIMOTHY JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:PROCTOR
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 1:11882 GREENVILLE AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3567
Mailing Address - Country:US
Mailing Address - Phone:972-644-8686
Mailing Address - Fax:972-644-8688
Practice Address - Street 1:11882 GREENVILLE AVE STE 107
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3567
Practice Address - Country:US
Practice Address - Phone:972-644-8686
Practice Address - Fax:972-644-8688
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32021103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic