Basic Information
| Provider Information | |||||||||
| NPI: | 1558450809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLVIN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | HARPER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1504 BROOKHOLLOW DR | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2900 BRISTOL ST | ||||||||
| Address2: | SUITE A207 | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926265981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492904922 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 44052 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.