Provider Demographics
NPI:1326329988
Name:STAUFFER, TIMOTHY (PC-CR)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:M
Credentials:PC-CR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9704
Mailing Address - Country:US
Mailing Address - Phone:614-949-6227
Mailing Address - Fax:614-451-3017
Practice Address - Street 1:1115 BETHEL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2690
Practice Address - Country:US
Practice Address - Phone:614-949-6227
Practice Address - Fax:614-451-3017
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0600937-CR101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional