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General NPI Number Information
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NPI Number | 1760702740
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Entity Type | Individual
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Provider Name | RONALD LEE TIMMCKE M.A
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Gender | Male
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 4253 MONTGOMERY BLVD NE SUITE 220
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-1106
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Country | US
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Telephone | 505-342-0400
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Fax | 505-342-0500
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Provider Business Mailing Address
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Address Line | 13204 SILVER PEAK PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8261
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Country | US
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Telephone | 505-850-7301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3907
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2741
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License Number State | NM
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