# TIMOTHY COLLISTER PHD, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932224987
- **Authorized official:** KARLA ELIZABETH PEREZ M.A. (MFT INTERN)
- **Authorized official phone:** (626) 914-9609

## Contact information

- **Practice address:** 7024 SEVILLE AVE STE D, HUNTINGTON PARK, CA 90255-4969
- **Practice address phone:** (323) 588-9600
- **Practice address fax:** (323) 588-9696
- **Mailing address:** 13525 TRACY ST APT A, BALDWIN PARK, CA 91706-4766
- **Mailing address phone:** (626) 813-9548
- **Mailing address fax:** (626) 813-9548

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | IMF51448 | CA | Yes |

## Other

- **Enumeration date:** 03/20/2007
- **Last updated:** 08/22/2020