Provider Demographics
NPI:1316017718
Name:AADLAND TILLOTSON, REBECCA D (LMFT, NCC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:AADLAND TILLOTSON
Suffix:
Gender:F
Credentials:LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15492 ELM RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-3922
Mailing Address - Country:US
Mailing Address - Phone:952-926-7500
Mailing Address - Fax:952-903-9257
Practice Address - Street 1:6542 REGENCY LN STE 209
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-926-7500
Practice Address - Fax:952-903-9257
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC 63137101YM0800X
MN1084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350J2SCOtherBLUE CROSS BLUE SHIELD
MN846855900OtherMHCP
MN50078-01OtherBHP
MN350J1AAOtherBLUE CROSS BLUE SHIELD
MN489632OtherVALUE OPTIONS
MN6293456OtherMEDICA
MN6879612Medicaid
MN6293456OtherUBH
MN6879612OtherMINNESOTA TAX ID
MN602360OtherMAYO