Provider Demographics
NPI:1790568012
Name:TILLMAN, JENNIFER NICHOLE (LMHCA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N OLYMPIC AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1322
Mailing Address - Country:US
Mailing Address - Phone:360-572-8655
Mailing Address - Fax:
Practice Address - Street 1:307 N OLYMPIC AVE STE 234
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1322
Practice Address - Country:US
Practice Address - Phone:360-572-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61284238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health