Provider Demographics
NPI:1437465374
Name:TIMMERMAN, DAVE (PCC, CRC)
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:
Last Name:TIMMERMAN
Suffix:
Gender:M
Credentials:PCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 ALGONQUIN PKWY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3713
Mailing Address - Country:US
Mailing Address - Phone:419-475-2300
Mailing Address - Fax:
Practice Address - Street 1:2809 ALGONQUIN PKWY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3713
Practice Address - Country:US
Practice Address - Phone:419-475-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health