Provider Demographics
NPI:1730486663
Name:WILLOWDEAN D. TILLER, INC.
Entity Type:Organization
Organization Name:WILLOWDEAN D. TILLER, INC.
Other - Org Name:ACCOLADE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLOWDEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:TILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:850-640-1020
Mailing Address - Street 1:128 CHRISTIE LN
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 JENKS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2576
Practice Address - Country:US
Practice Address - Phone:850-640-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6007251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health