Anderson, Timothy A

Anderson, Timothy A is an sole proprietor health care provider with primary practice located at 1626 Ne Bryant St , Portland OR 97211-4712. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Anderson, Timothy A can be contacted via phone (503) 936-5067.

Contact Information

Primary practice address
1626 Ne Bryant St Portland OR 97211-4712
Phone: (503) 936-5067
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X PSO17610 Pennsylvania
Behavioral Health & Social Service Providers / Psychologist 103T00000X 867 Nebraska
Behavioral Health & Social Service Providers / Clinical 103TC0700X 867 Nebraska
Behavioral Health & Social Service Providers / Psychologist 103T00000X 2684 Oregon

Profile Details

NPI number 1932226826
LBN Legal business name Anderson, Timothy A
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 23rd, 2007
Last updated Dec 5th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932226826 NPPES
Oregon MEDICAID 022959
Oregon MEDICAID 096511

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