Individual
TIMOTHY IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
609 NE BAKER ST STE 260, MCMINNVILLE, OR 97128-4950
(971) 213-5025
Mailing address
609 NE BAKER ST STE 260, MCMINNVILLE, OR 97128-4950
(971) 213-5025
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C7975
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500725204
—
OR
Enumeration date
05/11/2017
Last updated
06/05/2026
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