Provider Demographics
NPI:1912555327
Name:TIMS, IVIE S
Entity Type:Individual
Prefix:MS
First Name:IVIE
Middle Name:S
Last Name:TIMS
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 1:9535 OAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6101
Mailing Address - Country:US
Mailing Address - Phone:775-230-2314
Mailing Address - Fax:
Practice Address - Street 1:9535 OAKLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6101
Practice Address - Country:US
Practice Address - Phone:775-843-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV27-2976428Medicaid