Provider Demographics
NPI:1972040061
Name:O'CONNELL, TIMOTHY (CATC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10281 KIDD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3469
Mailing Address - Country:US
Mailing Address - Phone:951-715-5050
Mailing Address - Fax:800-498-8847
Practice Address - Street 1:10281 KIDD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3469
Practice Address - Country:US
Practice Address - Phone:951-715-5050
Practice Address - Fax:800-498-8847
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 175T00000X
CA2114485101YA0400X
CA19609101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist