Provider Demographics
NPI:1598453680
Name:TIMAH, CLOTEI (DO)
Entity Type:Individual
Prefix:
First Name:CLOTEI
Middle Name:
Last Name:TIMAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CLOTEL
Other - Middle Name:
Other - Last Name:TIMAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:9945 GOOD LUCK RD APT 103
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3265
Mailing Address - Country:US
Mailing Address - Phone:240-791-8334
Mailing Address - Fax:
Practice Address - Street 1:TRADEX VILLAGE
Practice Address - Street 2:
Practice Address - City:DOUALA
Practice Address - State:CAMEROON
Practice Address - Zip Code:10001
Practice Address - Country:CM
Practice Address - Phone:202-407-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Single Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool