Provider Demographics
NPI:1003218355
Name:TILLMAN, CANDICE ELAINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:ELAINE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16411 DAWNCREST WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7164
Mailing Address - Country:US
Mailing Address - Phone:713-614-4597
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 215
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-614-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional