MEDICARE: TYMEOUT COUNSELING AND CONSULTING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency
3	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1710818190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYMEOUT COUNSELING AND CONSULTING SERVICES, LLC

Provider Business Mailing Address
First Line	:	301 N ELM ST STE 638
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2083
Country	:	US
Telephone Number	:	336-762-7071
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N ELM ST STE 638
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27401-2083
Country	:	US
Telephone Number	:	336-762-7071
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NICOLE Y MOORE
Credential	:
Telephone Number	:	336-762-7071

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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