Provider Demographics
NPI:1417297748
Name:TODD, TIMOTHY JAY (LPC MHSP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:TODD
Suffix:
Gender:M
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MCCALLIE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2927
Mailing Address - Country:US
Mailing Address - Phone:423-255-7317
Mailing Address - Fax:
Practice Address - Street 1:1400 MCCALLIE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2927
Practice Address - Country:US
Practice Address - Phone:423-255-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2884101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional