Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Timothy William Pettett, SUDRC16547

Individual provider Counselor · NPI 1104545490

Timothy William Pettett, SUDRC16547 is a Counselor in San Jose, California. Licensed in California. Registered with an NPI since 2022.

Licensed in
CA
In the registry since
2022

Practice location Address checks out

298 Bernal Rd
San Jose, CA 95119-1809
Phone: (510) 337-7950
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Counselor (primary) Taxonomy 101Y00000X (CA)

Record details

NPI number1104545490
Entity typeIndividual (Type 1)
GenderMale
Credentials SUDRC16547
Sole proprietorNo
NPI enumeratedAugust 22, 2022
Last updated in NPPESOctober 20, 2024
Certification dateOctober 20, 2024

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