Provider Demographics
NPI:1235578972
Name:TILLEY, SARAH (MA, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TILLEY
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 WHITEHEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-4102
Mailing Address - Country:US
Mailing Address - Phone:757-753-1939
Mailing Address - Fax:
Practice Address - Street 1:400 THOMAS DRIVE
Practice Address - Street 2:UNIT 7108
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408
Practice Address - Country:US
Practice Address - Phone:515-373-8391
Practice Address - Fax:515-993-9545
Is Sole Proprietor?:No
Enumeration Date:2013-06-16
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005307101YP2500X
WYLPC-13607101YP2500X
FL16517101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional