Healthcare Provider Details

I. General information

NPI: 1598453680
Provider Name (Legal Business Name): CLOTEI TIMAH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CLOTEL TIMAH DO

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TRADEX VILLAGE
DOUALA CAMEROON
10001
CM

IV. Provider business mailing address

9945 GOOD LUCK RD APT 103
LANHAM MD
20706-3265
US

V. Phone/Fax

Practice location:
  • Phone: 202-407-2383
  • Fax:
Mailing address:
  • Phone: 240-791-8334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: