Provider Demographics
NPI:1922290436
Name:ADAMS, TIMOTHY E (LCSW)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:E
Last Name:ADAMS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E 1200 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6905
Mailing Address - Country:US
Mailing Address - Phone:801-226-2255
Mailing Address - Fax:801-226-2578
Practice Address - Street 1:251 EAST 1200 SOUTH
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6905
Practice Address - Country:US
Practice Address - Phone:801-226-2255
Practice Address - Fax:801-226-2578
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT287810-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
02878103500001OtherBLUE CROSS
UT870298699000Medicaid
5995175OtherAETNA