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TIMOTHY WILLIAM PETTETT SUDRC #16547
NPI 1104545490
Counselor in San Jose, CA

Active since August 22, 2022
298 BERNAL RD, SAN JOSE, CA 95119(510) 337-7950 Get Directions Write a Review

NPPES record last updated: October 20, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Timothy William Pettett Sudrc #16547 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIMOTHY WILLIAM PETTETT SUDRC #16547 (NPI 1104545490) is an individual counselor in San Jose, California and active in the NPI registry since August 2022.

NPPES Registry Identity

NPI1104545490
Entity TypeIndividualMale
Primary Taxonomy101Y00000X
Provider Legal NameTIMOTHY WILLIAM PETTETTCredential: SUDRC #16547
Location Address298 BERNAL RDSan Jose, CA 95119-1809
Mailing Address298 Bernal RdSan Jose, CA 95119-1809 · (341) 348-3969
Phone(510) 337-7950
Sole ProprietorNo
Enumeration DateAugust 22, 2022
Last NPPES UpdateOctober 20, 2024
NPPES CertifiedOctober 20, 2024
✔ NPI 1104545490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselorBehavioral Health & Social Service Providers
Taxonomy Code101Y00000X
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
298 BERNAL RD, San Jose, CA 95119
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEFFERY RAY BOTT
Peer Specialist
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 780-0544
MISS FELICIA ANN HOFFMAN RESIDENTIAL COUN
Counselor (Mental Health)
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 404-8673
ALAN KINH ARMENTA
Counselor (Mental Health)
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 638-4744
SOKUNTHEA CHEA
Licensed Psychiatric Technician
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 404-8673
ALMA A MARTINEZ
Rehabilitation Counselor
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 498-7906
ARISTIDES MELGOZA PULIDO
Rehabilitation Practitioner
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 498-7906
MRS. BLANCA ALICIA CARRILLO-SERRANO A.S.W.
Social Worker (Clinical)
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (408) 629-0713
MARISELA VASQUEZ
Case Manager/Care Coordinator
298 BERNAL RD
SAN JOSE, CA 95119
Santa Clara County (669) 216-0076

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Timothy Pettett's NPI number?

The NPI number for Timothy Pettett is 1104545490. It was assigned to this individual provider in the NPPES registry on August 22, 2022.

Where is Timothy Pettett located?

Timothy Pettett practices at 298 Bernal Rd, San Jose, CA 95119. The listed phone number is (510) 337-7950.

What is Timothy Pettett's specialty?

The primary specialty registered for this NPI is Counselor with taxonomy code 101Y00000X.

When was this NPI record last updated?

The NPPES record for Timothy Pettett was last updated on October 20, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.