Provider Demographics
NPI:1841574191
Name:TILLMAN, JAMES CARL (LPCC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CARL
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30181 VIA RIVERA
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-4455
Mailing Address - Country:US
Mailing Address - Phone:1310-461-4107
Mailing Address - Fax:
Practice Address - Street 1:30181 VIA RIVERA
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-4455
Practice Address - Country:US
Practice Address - Phone:310-461-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health