Provider Demographics
NPI:1215050703
Name:WOODEN, TIMOTHY LEE (PSY D)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEE
Last Name:WOODEN
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 MISSION AVENUE
Mailing Address - Street 2:SUITE #111
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058
Mailing Address - Country:US
Mailing Address - Phone:760-810-1440
Mailing Address - Fax:
Practice Address - Street 1:3355 MISSION AVENUE
Practice Address - Street 2:SUITE #111
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-810-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical