Provider Demographics
NPI:1770774275
Name:HARLAN, TIMOTHY M (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:HARLAN
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 1:465 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-4582
Mailing Address - Country:US
Mailing Address - Phone:530-534-6934
Mailing Address - Fax:530-534-5463
Practice Address - Street 1:465 POMONA AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4582
Practice Address - Country:US
Practice Address - Phone:530-534-6934
Practice Address - Fax:530-534-5463
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA321737OtherVALUE OPTIONS
CA0001028588OtherMANAGED HEALTH NETWORK
CAZZZ90432ZOtherBLUE SHIELD