Individual
MR. TIMOTHY JAMES PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5200 SW MACADAM AVE, #580, PORTLAND, OR 97239-3837
(503) 231-7854
(503) 231-8153
Mailing address
5200 SW MACADAM AVE, #580, PORTLAND, OR 97239-3837
(503) 231-7854
(503) 231-8153
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
L3666
OR
104100000X
Social Worker
LW00008136
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278487
—
OR
Enumeration date
05/03/2006
Last updated
12/28/2021
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