Provider Demographics
NPI:1558761254
Name:COONROD, TIMOTHY E (NCC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:COONROD
Suffix:
Gender:M
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-6635
Mailing Address - Country:US
Mailing Address - Phone:850-456-5886
Mailing Address - Fax:850-456-9403
Practice Address - Street 1:4504 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-6635
Practice Address - Country:US
Practice Address - Phone:850-456-5886
Practice Address - Fax:850-456-9403
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health