Provider Demographics
NPI:1629377585
Name:TIMMONS, SARA ELIZABETH (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 KENDALE BLVD
Mailing Address - Street 2:SUITE 95
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 KENDALE BLVD
Practice Address - Street 2:SUITE 95
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2076
Practice Address - Country:US
Practice Address - Phone:219-742-9167
Practice Address - Fax:517-489-4444
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006428106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist