Provider Demographics
NPI:1154933695
Name:SCUDDER, TIMOTHY LEE (LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:SCUDDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WEBER ST STE 245
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1019
Mailing Address - Country:US
Mailing Address - Phone:719-362-0558
Mailing Address - Fax:719-316-5658
Practice Address - Street 1:731 N WEBER ST STE 245
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1019
Practice Address - Country:US
Practice Address - Phone:719-362-0558
Practice Address - Fax:719-316-5658
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional