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Organization
TIMOTHY COLLISTER PHD & ASSOCIATES, INC
Active
Organization
TIMOTHY COLLISTER PHD & ASSOCIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY D COLLISTER PHD (PRESIDENT)
(323) 588-9600
Entity
Organization
Contact information
Practice address
7024 SEVILLE AVE STE D, HUNTINGTON PARK, CA 90255-4969
(323) 588-9600
Mailing address
1441 HUNTINGTON DR, SOUTH PASADENA, CA 91030-4512
(323) 588-9600
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY12985
CA
103TC2200X
Clinical Child & Adolescent Psychologist
PSY12895
CA
103TF0000X
Family Psychologist
PSY12895
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY128951
—
CA
05
—
PSY12950
—
CA
Enumeration date
12/27/2006
Last updated
11/27/2007
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