MEDICARE: DANIELLE TIMMONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	I.0800276	OH

General Provider Information

NPI Number	:	1437666963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIELLE TIMMONS LLC

Provider Business Mailing Address
First Line	:	4745 FAY DR
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-3884
Country	:	US
Telephone Number	:	216-789-4347
Fax Number	:

Provider Business Practice Location Address
First Line	:	12417 CEDAR RD STE 21
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3157
Country	:	US
Telephone Number	:	216-583-0183
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	DANIELLE TIMMONS
Credential	:	LISW-S
Telephone Number	:	216-789-4347

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	01/05/2018

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