Provider Demographics
NPI:1427487628
Name:PAVLATOS, TIMOTHY (MS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:PAVLATOS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 SE LAKE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-2148
Mailing Address - Country:US
Mailing Address - Phone:503-652-2810
Mailing Address - Fax:503-652-8553
Practice Address - Street 1:6902 SE LAKE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-2148
Practice Address - Country:US
Practice Address - Phone:503-652-2810
Practice Address - Fax:503-652-8553
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional