Provider Demographics
NPI:1750108056
Name:FRAISER, TIMOTHY MATTHEW (MFT-INT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MATTHEW
Last Name:FRAISER
Suffix:
Gender:M
Credentials:MFT-INT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 NEW JOURNEY WAY
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0533
Mailing Address - Country:US
Mailing Address - Phone:702-277-8955
Mailing Address - Fax:
Practice Address - Street 1:3243 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3185
Practice Address - Country:US
Practice Address - Phone:702-434-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist