Provider Demographics
NPI:1205006616
Name:TIMMONS-MITCHELL, JANE CHRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CHRISTINA
Last Name:TIMMONS-MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 E OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2435
Mailing Address - Country:US
Mailing Address - Phone:216-321-7890
Mailing Address - Fax:216-397-1107
Practice Address - Street 1:2995 E OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-2435
Practice Address - Country:US
Practice Address - Phone:216-321-7890
Practice Address - Fax:216-397-1107
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3478103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH704072Medicaid