Provider Demographics
NPI:1497271837
Name:TIMMONS, TERRY V (LPC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:V
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-8003
Mailing Address - Country:US
Mailing Address - Phone:662-401-4908
Mailing Address - Fax:
Practice Address - Street 1:1018 N GLOSTER ST STE F
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-1234
Practice Address - Country:US
Practice Address - Phone:662-540-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2215101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1497271837OtherN/A