Provider Demographics
NPI:1518044379
Name:TIMKO, CHERI (MS)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:
Last Name:TIMKO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 LICK RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8856
Mailing Address - Country:US
Mailing Address - Phone:304-534-8227
Mailing Address - Fax:304-363-2287
Practice Address - Street 1:14 E. FAIRMONT ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-534-8227
Practice Address - Fax:304-534-3535
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1659101YP2500X
WV101YP2500X
WV1917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD591478000OtherMAGELLAN HEALTH SERVICES
MD325998OtherMHN PROVIDER NUMBRE
MD403920300Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER