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Organization
SALLY A TIMMONS LLC
Active
Organization
SALLY A TIMMONS LLC
Active
Parent organization
SALLY A TIMMONS LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SALLY A TIMMONS LLC
Authorized official
SALLY ANN TIMMONS LCSW RN (REGISTERED AGENT)
(765) 404-6431
Entity
Organization
Contact information
Practice address
120 SAGAMORE PARKWAY WEST, WEST LAFAYETTE, IN 47906
(765) 404-6431
(765) 477-7843
Mailing address
1805 SKYLINE RD, LAFAYETTE, IN 47905
(765) 404-6431
(765) 477-7843
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004910A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000375779
ANTHEM BCBS
IN
Enumeration date
08/08/2007
Last updated
11/15/2007
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