Provider Demographics
NPI:1255474789
Name:TILLMAN-LIND, TAMMY LYNNE (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNNE
Last Name:TILLMAN-LIND
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:LYNNE
Other - Last Name:GATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8304 N 101ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2365
Mailing Address - Country:US
Mailing Address - Phone:187-401-7359
Mailing Address - Fax:
Practice Address - Street 1:4400 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5104
Practice Address - Country:US
Practice Address - Phone:405-424-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3622LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional