Provider Demographics
NPI:1679963219
Name:TIMMONS, AMY J (PCC, LICDC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:PCC, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 N 13TH ST STE 420
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7264
Mailing Address - Country:US
Mailing Address - Phone:419-720-9247
Mailing Address - Fax:
Practice Address - Street 1:1776 TREMAINSVILLE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4039
Practice Address - Country:US
Practice Address - Phone:419-214-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000039-SUPV101YP2500X
OHLICDC.131086101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)