Provider Demographics
NPI:1104815448
Name:PRIESS, TIMA C (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:TIMA
Middle Name:C
Last Name:PRIESS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:ESTER
Mailing Address - State:AK
Mailing Address - Zip Code:99725-0213
Mailing Address - Country:US
Mailing Address - Phone:907-452-8438
Mailing Address - Fax:
Practice Address - Street 1:543 3RD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4732
Practice Address - Country:US
Practice Address - Phone:907-452-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist