Provider Demographics
NPI:1417535733
Name:STOTTS, TIMMICIA J (MS, T-LMFT)
Entity Type:Individual
Prefix:
First Name:TIMMICIA
Middle Name:J
Last Name:STOTTS
Suffix:
Gender:F
Credentials:MS, T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GRAND AVE APT 83
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5013
Mailing Address - Country:US
Mailing Address - Phone:515-779-7895
Mailing Address - Fax:
Practice Address - Street 1:1200 VALLEY WEST DR STE 508
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1906
Practice Address - Country:US
Practice Address - Phone:515-267-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA106314106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist