Provider Demographics
NPI:1023983483
Name:TIMMONS, MIKELLE LYNNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MIKELLE
Middle Name:LYNNE
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E 500 N
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2515
Mailing Address - Country:US
Mailing Address - Phone:385-367-4330
Mailing Address - Fax:
Practice Address - Street 1:72 E 500 N
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2515
Practice Address - Country:US
Practice Address - Phone:385-367-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12739888-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty