Provider Demographics
NPI:1629651369
Name:TIMMONS, PAMMY LSHEA
Entity Type:Individual
Prefix:
First Name:PAMMY
Middle Name:LSHEA
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 E RENO AVE UNIT D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4715
Mailing Address - Country:US
Mailing Address - Phone:725-735-0049
Mailing Address - Fax:
Practice Address - Street 1:1407 E RENO AVE UNIT D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4715
Practice Address - Country:US
Practice Address - Phone:725-735-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2105392566Medicaid