Tillman, Jasmine Latriece

Tillman, Jasmine Latriece is an sole proprietor health care provider with primary practice located at 19853 Outer Dr Ste 110 , Dearborn MI 48124-2044. She recently has only one registered license in Behavioral Health & Social Service Providers / Assistant Behavior Analyst, which is considered as her primary health care specialty. Tillman, Jasmine Latriece can be contacted via phone (313) 406-5056.

Contact Information

Primary practice address
19853 Outer Dr Ste 110 Dearborn MI 48124-2044
Phone: (313) 406-5056
Fax: (248) 712-4381
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Assistant Behavior Analyst 106E00000X 7402000124 Michigan

Profile Details

NPI number 1275036162
LBN Legal business name Tillman, Jasmine Latriece
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 16th, 2018
Last updated Jun 10th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275036162 NPPES
Michigan MEDICAID 386004894

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