Basic Information
| Provider Information | |||||||||
| NPI: | 1447228432 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLEWELLYN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPCC, LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2935 BOGGS RD | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437019175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404540263 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2845 BELL ST | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404549766 | ||||||||
| FaxNumber: | 7405886452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E1098 | OH | X | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | I3342 | OH | X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 142131 | 01 | OH | COMPSYCH BH PIN | OTHER | 7978296 | 01 | OH | AETNA PIN | OTHER | Y453948 | 01 | OH | THE HEALTH PLAN PIN | OTHER | 212257 | 01 | OH | TRICARE/MHN PIN | OTHER | 133201 | 01 | OH | MOUNT CARMEL PIN | OTHER |