Provider Demographics
NPI:1578627600
Name:TILLMAN, TERRAH (MA)
Entity Type:Individual
Prefix:
First Name:TERRAH
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GROTH CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1053
Mailing Address - Country:US
Mailing Address - Phone:916-595-7315
Mailing Address - Fax:916-482-0635
Practice Address - Street 1:2710 X ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2757
Practice Address - Country:US
Practice Address - Phone:916-595-7315
Practice Address - Fax:916-482-0635
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist