TIM O'CONNELL (NPI# 1972040061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972040061 |
| Entity Type | Individual |
| Full Name | TIM O'CONNELL |
| Credential | RADT |
| Practice Address |
2085 Rustin Ave Bldg 1 Riverside CA 92507-2498 |
| Mailing Address |
2085 Rustin Ave Riverside CA 92507-2498 |
| Practice Telephone | 9517822400 |
| Practice Fax Number | 9517849176 |
| Mailing Telephone | 9519557620 |
| Mailing Fax Number | 9517849176 |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2020-07-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 175T00000X | Peer Specialist | Other Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2275 E Cooley Dr, Colton, CA 923246324 | 9095430790 | |
| 9990 County Farm Rd., Suite #6, Riverside, CA 92503 | 9515092499 |
| Street Address |
2085 RUSTIN AVE BLDG 1 |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92507-2498 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448917 | Rachel Nielson | Counselor | 1450 Spruce St, Suite A, Riverside, CA 92507 | 2020-08-24 |
| 1437769742 | Pakravan, Manavi & Cohen Dental Corporation | Dentist | 2862 Unit B Canyon Springs Parkway, Riverside, CA 92507 | 2020-08-03 |
| 1518577972 | Michael Vincent Laureola Dds Inc | Dentist | 2862 Unit A Canyon Springs Parkway, Riverside, CA 92507 | 2020-07-31 |
| 1164067567 | Audrey Gruen | Social Worker | Canyon Crest Mental Health, 5225 Canyon Crest Drive #100, Riverside, CA 92507 | 2019-11-10 |
| 1518432962 | Antonio Mixon | Specialist | 1405 Spruce Street, Suite A, Riverside, CA 92507 | 2018-10-11 |
| 1811479793 | New Day Counseling Services | Counselor | 20363 Harvard Way, Riverside, CA 92507 | 2018-09-06 |
| 1780176875 | Miriam Martinez | Case Manager/Care Coordinator | 2085 Rustin Ave., Riverside, CA 92507 | 2018-06-04 |
| 1518478874 | Lisa Manuel | Counselor | 2058 Rustin Ave, Riverside, CA 92507 | 2017-10-13 |
| 1497272942 | Yajaira Placensia | Behavioral Analyst | 1486 Everton Place, Riverside, CA 92507 | 2017-08-25 |
| 1841717691 | Stephanie Teuchert | Behavioral Analyst | 1080 Spruce Street Apartment 7c, Riverside, CA 92507 | 2017-08-23 |
| Find all providers in zip 92507 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649884248 | Jose G. Cruz Rodriguez | Counselor | 66 Planet Ave, Riverside, RI 02915-2172 | 2020-09-02 |
| 1124585500 | Cesar Quintana | Counselor | 7177 Brockton Ave Ste 444, Riverside, CA 92506-2635 | 2019-02-21 |
| 1740759067 | Kristina Ferris-celosse | Counselor | 2452 Wilshire St., Riverside, CA 92501 | 2018-11-15 |
| 1750895298 | Tanisha Jordan Balogun | Counselor | 17270 Roosevelt St # 304, Riverside, CA 92508-9523 | 2017-11-20 |
| 1790207058 | Albert Anthony Silva | Counselor | 80 Cove St, Riverside, RI 02915-3637 | 2017-07-07 |
| 1215397757 | Renee Machado | Counselor | 5484 Cedar St, Riverside, CA 92509-3746 | 2016-02-25 |
| 1831561299 | Alysia Webb | Counselor | 11359 Dole Ct, Riverside, CA 92505-2353 | 2015-10-26 |
| 1053796110 | Jessica Anne Pellegrin | Counselor | 3576 Arlington Ave Suite 102 & 104, Riverside, CA 92506-3907 | 2015-07-29 |
| 1346632379 | Jessica Molina | Counselor | 6860 Brockton Ave # 9, Riverside, CA 92506-3821 | 2015-02-27 |
| 1144610494 | Michael Julius Morris I | Counselor | 5870 Arlington Ave., Riverside, CA 92504 | 2015-01-26 |
| Find all providers in RIVERSIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.