Healthcare Provider Details

I. General information

NPI: 1477054955
Provider Name (Legal Business Name): BROOKE TIMM CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

IV. Provider business mailing address

45 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2343
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-8242
  • Fax: 330-642-8242
Mailing address:
  • Phone: 330-642-8242
  • Fax: 330-642-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number165626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number168898
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168898
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: