Provider Demographics
NPI:1790460384
Name:TILLMAN, RYLEE MARIE (NCC)
Entity Type:Individual
Prefix:MRS
First Name:RYLEE
Middle Name:MARIE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SANGA CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-6573
Mailing Address - Country:US
Mailing Address - Phone:815-321-3210
Mailing Address - Fax:
Practice Address - Street 1:800 SANGA CREEK RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6573
Practice Address - Country:US
Practice Address - Phone:815-321-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1534326101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor