Provider Demographics
NPI:1043412091
Name:MEADE, TIMOTHY A (MS, NCC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:MEADE
Suffix:
Gender:M
Credentials:MS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2478 13TH ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2522
Mailing Address - Country:US
Mailing Address - Phone:503-561-5582
Mailing Address - Fax:
Practice Address - Street 1:2478 13TH ST SE STE 200
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2522
Practice Address - Country:US
Practice Address - Phone:503-561-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health