Healthcare Provider Details

I. General information

NPI: 1275929614
Provider Name (Legal Business Name): TIM CARMAN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 HUSTONVILLE RD STE 7
DANVILLE KY
40422-2165
US

IV. Provider business mailing address

PO BOX 188
WILLISBURG KY
40078-0188
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-9598
  • Fax:
Mailing address:
  • Phone: 859-375-9200
  • Fax: 859-375-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00218271
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number244480
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: