Provider Demographics
NPI:1780965426
Name:JOE TIMMINS LCSW, INC.
Entity type:Organization
Organization Name:JOE TIMMINS LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TIMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-572-3750
Mailing Address - Street 1:12176 S 1000 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9734
Mailing Address - Country:US
Mailing Address - Phone:801-572-3750
Mailing Address - Fax:801-572-1097
Practice Address - Street 1:12176 S 1000 E
Practice Address - Street 2:SUITE C
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9734
Practice Address - Country:US
Practice Address - Phone:801-572-3750
Practice Address - Fax:801-572-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT961146643501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health