1447228432 NPI number — TIMOTHY M LLEWELLYN LPCC, LISW

Table of content: TIMOTHY M LLEWELLYN LPCC, LISW (NPI 1447228432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447228432 NPI number — TIMOTHY M LLEWELLYN LPCC, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLEWELLYN
Provider First Name:
TIMOTHY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC, LISW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447228432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2935 BOGGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZANESVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43701-9175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-454-0263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2845 BELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZANESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43701-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-454-9766
Provider Business Practice Location Address Fax Number:
740-588-6452
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  E1098 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: I3342 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 142131 . This is a "COMPSYCH BH PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7978296 . This is a "AETNA PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: Y453948 . This is a "THE HEALTH PLAN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 212257 . This is a "TRICARE/MHN PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 133201 . This is a "MOUNT CARMEL PIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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