Provider Demographics
NPI:1043882483
Name:TILGHMAN, GLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:TILGHMAN
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 1:196 PREACHER DOWLAND RD
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38233-3071
Mailing Address - Country:US
Mailing Address - Phone:731-445-0908
Mailing Address - Fax:
Practice Address - Street 1:374 N PARKWAY STE B4
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2895
Practice Address - Country:US
Practice Address - Phone:731-300-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82511041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical