Basic Information
| Provider Information | |||||||||
| NPI: | 1083039432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRVING | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 490 N GRAPE ST # CA92025 | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609759939 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 28999 OLD TOWN FRONT ST | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925905805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512618392 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2014 | ||||||||
| LastUpdateDate: | 10/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 97197 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.