Provider Demographics
NPI:1700904240
Name:TIMKO COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TIMKO COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMKO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:304-680-7622
Mailing Address - Street 1:421 LICK RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8856
Mailing Address - Country:US
Mailing Address - Phone:304-680-7622
Mailing Address - Fax:304-363-2287
Practice Address - Street 1:109 FAIRMONT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2815
Practice Address - Country:US
Practice Address - Phone:304-680-7622
Practice Address - Fax:304-363-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1659101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD72912400OtherMAGELLAN