Provider Demographics
NPI:1811359664
Name:PHILLIPS, TIMOTHY C
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15514 SW PEACE AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-2279
Mailing Address - Country:US
Mailing Address - Phone:971-727-5374
Mailing Address - Fax:
Practice Address - Street 1:6950 SW HAMPTON ST STE 221
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8331
Practice Address - Country:US
Practice Address - Phone:503-912-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health