Provider Demographics
NPI:1720792989
Name:CHILDRESS, TYMESHIA LAJOYCE (CTRS)
Entity type:Individual
Prefix:
First Name:TYMESHIA
Middle Name:LAJOYCE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S ERIE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8291
Mailing Address - Country:US
Mailing Address - Phone:419-944-7020
Mailing Address - Fax:
Practice Address - Street 1:5726 SOUTHWYCK BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1559
Practice Address - Country:US
Practice Address - Phone:419-708-0441
Practice Address - Fax:419-932-6599
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty