Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1124380498 |
---|---|
Provider Name | Adela Timmons |
First Address | Santa Monica, CA 90405-1806 |
Second Address | Torrance, CA 90502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 13/06/2012 |