Provider Demographics
NPI:1225339351
Name:PLATT, TIMOTHY ALAN (LPC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:PLATT
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 1:7060 E SAHUARITA RD
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-9391
Mailing Address - Country:US
Mailing Address - Phone:520-867-5889
Mailing Address - Fax:
Practice Address - Street 1:333 W WILCOX DR STE 202
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1790
Practice Address - Country:US
Practice Address - Phone:520-867-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67105101YP2500X
AZ16756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional