Provider Demographics
NPI:1194531095
Name:MATHIS, TIMOTHY T (PPS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:T
Last Name:MATHIS
Suffix:
Gender:M
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14250 WEST DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-5655
Mailing Address - Country:US
Mailing Address - Phone:760-251-7220
Mailing Address - Fax:
Practice Address - Street 1:14250 WEST DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-5655
Practice Address - Country:US
Practice Address - Phone:760-251-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool