Provider Demographics
NPI:1245355627
Name:ELLINGER, TIMOTHY CRAIG
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:CRAIG
Last Name:ELLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 W SWEET CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9140
Mailing Address - Country:US
Mailing Address - Phone:317-861-9763
Mailing Address - Fax:
Practice Address - Street 1:850 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1098
Practice Address - Country:US
Practice Address - Phone:317-554-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002891A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical