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NPI Code Detail

MEDICARE: AMY J TIMMONS PCC, LICDC

MEDICARE: AMY J TIMMONS PCC, LICDC
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
1101YP2500XProfessional CounselorE.1000039-SUPVOH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.131086OH

General Provider Information

NPI Number : 1679963219
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY J TIMMONS PCC, LICDC
Provider Business Mailing Address
First Line : 1946 N 13TH ST STE 420
Second Line :
City : TOLEDO
State : OH
Zip : 43604-7264
Country : US
Telephone Number : 419-720-9247
Fax Number :
Provider Business Practice Location Address
First Line : 1776 TREMAINSVILLE RD
Second Line :
City : TOLEDO
State : OH
Zip : 43613-4039
Country : US
Telephone Number : 419-214-0606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2015
Last Update Date : 03/17/2018

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