Provider Demographics
NPI:1053487892
Name:TIMM, LIUDMILA PETROVNA (LPCC)
Entity Type:Individual
Prefix:
First Name:LIUDMILA
Middle Name:PETROVNA
Last Name:TIMM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 W BUSH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-1321
Mailing Address - Country:US
Mailing Address - Phone:952-941-5217
Mailing Address - Fax:
Practice Address - Street 1:499 WACOUTA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2355
Practice Address - Country:US
Practice Address - Phone:651-528-9410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional