| Doctor Name: | TIM L KOBERLEIN |
| NPI Number: | 1235551011 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | L6076 |
| Business Practice Address: | 1611 N Whitley Dr Fruitland, ID - 836192177 |
| Business Phone Number: | 2082911020 |
| Business Fax Number: | 2084525842 |
| Mailing Address: | 702 Sunset Dr, ONTARIO |
| State: | OR |
| Postal Code: | 979143121 |
| Phone Number: | 5418899167 |
| Fax Number: | 5418897873 |
| NPI Enumeration Date: | 01/13/2014 |
| NPI Last Update Date: | 08/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | L6076 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |