Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | PC002136 | PA |
N | 103K00000X | Behavior Analyst | 1-01-0675 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS016722 | PA |
Y | 103G00000X | Clinical Psychologist | PS016722 | PA |
Y | 103TC0700X | Clinical Psychologist | PS016722 | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS016722 | PA |
NPI | 1023281557 |
---|---|
Provider Name | Dr. Stephen M Timchack |
First Address | Kingston, PA 18704-5512 |
Second Address | Kingston, PA 18704-5512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 27/03/2012 |