Provider Demographics
NPI:1730233792
Name:TIMMONS, MARY ELIZABETH LIBBY (LISAC CEAP SAP)
Entity type:Individual
Prefix:MS
First Name:MARY ELIZABETH
Middle Name:LIBBY
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:LISAC CEAP SAP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:TIMMONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 64002
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728
Mailing Address - Country:US
Mailing Address - Phone:520-327-5522
Mailing Address - Fax:520-327-5525
Practice Address - Street 1:1661 N SWAN RD
Practice Address - Street 2:SUITE 234
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-327-5522
Practice Address - Fax:520-327-5525
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 1642101YA0400X
AZ1713101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)