Provider Demographics
NPI:1306616966
Name:TIMMONS, JASON LOUIE (RADT1)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LOUIE
Last Name:TIMMONS
Suffix:
Gender:M
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10087 TERRA LOMA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3202
Mailing Address - Country:US
Mailing Address - Phone:916-521-4555
Mailing Address - Fax:
Practice Address - Street 1:10087 TERRA LOMA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-3202
Practice Address - Country:US
Practice Address - Phone:916-521-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1403990920101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)