Provider Demographics
NPI:1386397768
Name:GILES, TIM RAMON
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:RAMON
Last Name:GILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 VILLA SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3716
Mailing Address - Country:US
Mailing Address - Phone:313-855-9538
Mailing Address - Fax:
Practice Address - Street 1:1627 VILLA SOUTH DR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3716
Practice Address - Country:US
Practice Address - Phone:313-855-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician