Provider Demographics
NPI:1699668863
Name:THREE TWELVE LLC
Entity type:Organization
Organization Name:THREE TWELVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:WIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-509-5670
Mailing Address - Street 1:5057 CARILLON LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3117
Mailing Address - Country:US
Mailing Address - Phone:515-509-5670
Mailing Address - Fax:
Practice Address - Street 1:5057 CARILLON LN
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3117
Practice Address - Country:US
Practice Address - Phone:515-509-5670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)