Provider Demographics
NPI:1659907079
Name:TIMKO, ELAINE BLACK (LPC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:BLACK
Last Name:TIMKO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MACRAE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-4228
Mailing Address - Country:US
Mailing Address - Phone:724-992-2244
Mailing Address - Fax:
Practice Address - Street 1:113D NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127
Practice Address - Country:US
Practice Address - Phone:724-992-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional