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General NPI Number Information
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NPI Number | 1871784330
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Entity Type | Organization
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Legal Business Name | SALLY A TIMMONS LLC
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 120 SAGAMORE PARKWAY WEST
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906
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Country | US
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Telephone | 765-404-6431
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Fax | 765-477-7843
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Provider Business Mailing Address
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Address Line | 1805 SKYLINE RD
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City | LAFAYETTE
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State | IN
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Zip | 47905
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Country | US
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Telephone | 765-404-6431
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Fax | 765-477-7843
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | SALLY ANN TIMMONS
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Credential | LCSW RN
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Telephone | 765-404-6431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34004910A
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License Number State | IN
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