Provider Demographics
NPI:1306387931
Name:TRILLIUMWOOD COUNSELING SERVICES
Entity Type:Organization
Organization Name:TRILLIUMWOOD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN EVANS
Authorized Official - Last Name:FILLMORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMSW
Authorized Official - Phone:906-235-6750
Mailing Address - Street 1:4851 COUNTY ROAD 135
Mailing Address - Street 2:
Mailing Address - City:MCMILLAN
Mailing Address - State:MI
Mailing Address - Zip Code:49853
Mailing Address - Country:US
Mailing Address - Phone:906-235-6750
Mailing Address - Fax:
Practice Address - Street 1:4851 COUNTY ROAD 135
Practice Address - Street 2:
Practice Address - City:MC MILLAN
Practice Address - State:MI
Practice Address - Zip Code:49853-9452
Practice Address - Country:US
Practice Address - Phone:906-235-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801093490251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management