Provider Demographics
NPI:1235647801
Name:TILLMANNSHOFER, DENISE LEA
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LEA
Last Name:TILLMANNSHOFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 CHARLOTTE PIKE # 1260
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2926
Mailing Address - Country:US
Mailing Address - Phone:296-204-4422
Mailing Address - Fax:
Practice Address - Street 1:116 AGNES RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6306
Practice Address - Country:US
Practice Address - Phone:296-204-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5426101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional