Provider Demographics
NPI:1619463320
Name:THIMMES, SEAN ALLEN (RBT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ALLEN
Last Name:THIMMES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8897 SALMON FALLS DR APT B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-1932
Mailing Address - Country:US
Mailing Address - Phone:760-953-0590
Mailing Address - Fax:
Practice Address - Street 1:6000 J. STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-6073
Practice Address - Country:US
Practice Address - Phone:916-548-2562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-30386106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician