Provider Demographics
NPI:1275366759
Name:TIMME, ANDREW ELLIOT (MFT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ELLIOT
Last Name:TIMME
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 CROSS CREEK ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1817
Mailing Address - Country:US
Mailing Address - Phone:707-416-1171
Mailing Address - Fax:
Practice Address - Street 1:201 FAIR ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2516
Practice Address - Country:US
Practice Address - Phone:707-778-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134499106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist