Basic Information
| Provider Information | |||||||||
| NPI: | 1497208086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFFERTY | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10100 ELIDA RD | ||||||||
| Address2: | |||||||||
| City: | DELPHOS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458339056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194273302 | ||||||||
| FaxNumber: | 4194271697 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 STATE ROUTE 39 | ||||||||
| Address2: | |||||||||
| City: | SHELBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448759466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197473322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2016 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S.1501091 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.