Healthcare Provider Details

I. General information

NPI: 1679963219
Provider Name (Legal Business Name): AMY J TIMMONS PCC, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 TREMAINSVILLE RD
TOLEDO OH
43613-4039
US

IV. Provider business mailing address

1946 N 13TH ST STE 420
TOLEDO OH
43604-7264
US

V. Phone/Fax

Practice location:
  • Phone: 419-214-0606
  • Fax:
Mailing address:
  • Phone: 419-720-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.131086
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1000039-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: