Basic Information
| Provider Information | |||||||||
| NPI: | 1720616758 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCASKILL | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | GENE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3031 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900073033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233732400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3031 S VERMONT AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900073033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233732400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2020 | ||||||||
| LastUpdateDate: | 03/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 117801 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 117801 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | B9074273 | 01 | CA | DRIVERS LICENCE | OTHER |