Provider Demographics
NPI:1386515880
Name:TWO TIM ONE LLC
Entity type:Organization
Organization Name:TWO TIM ONE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LERMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-415-1536
Mailing Address - Street 1:2109 MAUREL
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3804
Mailing Address - Country:US
Mailing Address - Phone:832-713-6879
Mailing Address - Fax:
Practice Address - Street 1:2109 MAUREL
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3804
Practice Address - Country:US
Practice Address - Phone:832-713-6879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health