Provider Demographics
NPI:1447228432
Name:LLEWELLYN, TIMOTHY M (LPCC, LISW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:LPCC, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 BOGGS RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9175
Mailing Address - Country:US
Mailing Address - Phone:740-454-0263
Mailing Address - Fax:
Practice Address - Street 1:2845 BELL ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1720
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1098101YP2500X
OHI33421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH142131OtherCOMPSYCH BH PIN
OH7978296OtherAETNA PIN
OHY453948OtherTHE HEALTH PLAN PIN
OH212257OtherTRICARE/MHN PIN
OH133201OtherMOUNT CARMEL PIN