Provider Demographics
NPI:1518737535
Name:TILLMAN, RACHEL M (LPC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 N 166TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5124
Mailing Address - Country:US
Mailing Address - Phone:414-426-7944
Mailing Address - Fax:
Practice Address - Street 1:1760 N 166TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5124
Practice Address - Country:US
Practice Address - Phone:414-426-7944
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional