Provider Demographics
NPI:1043555311
Name:BARBOUR, TIMOTHY NELSON (LICSW)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:NELSON
Last Name:BARBOUR
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 RUSH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8004
Mailing Address - Country:US
Mailing Address - Phone:509-713-5802
Mailing Address - Fax:
Practice Address - Street 1:8121 W QUINAULT AVE STE F202
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8210
Practice Address - Country:US
Practice Address - Phone:509-713-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 601297421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical