Healthcare Provider Details

I. General information

NPI: 1497271837
Provider Name (Legal Business Name): TERRY V TIMMONS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N GLOSTER ST STE F
TUPELO MS
38804-1234
US

IV. Provider business mailing address

2639 OAKCREST DR
TUPELO MS
38804-8003
US

V. Phone/Fax

Practice location:
  • Phone: 662-540-5558
  • Fax:
Mailing address:
  • Phone: 662-401-4908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2215
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: