Tillman, Stephanie Ann
Tillman, Stephanie Ann is an sole proprietor health care provider with primary practice located at 820 Chamberlain Loop , Lake Wales FL 33853-2800. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Tillman, Stephanie Ann can be contacted via phone (863) 528-0402.Contact Information
Primary practice address
820 Chamberlain Loop
Lake Wales FL 33853-2800
Phone: (863) 528-0402
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | SW7484 | Florida |
Profile Details
| NPI number | 1417074014 |
|---|---|
| LBN Legal business name | Tillman, Stephanie Ann |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 26th, 2007 |
| Last updated | Jul 9th, 2007 - about 17 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417074014 | NPPES |
| Florida | MEDICAID | 7658389 |
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