Provider Demographics
NPI:1184291833
Name:TILLMAN, NSHEA (MS)
Entity type:Individual
Prefix:
First Name:NSHEA
Middle Name:
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:TILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20987 N JOHN WAYNE PKWY # B104-113
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2926
Mailing Address - Country:US
Mailing Address - Phone:520-858-3344
Mailing Address - Fax:
Practice Address - Street 1:20987 N JOHN WAYNE PKWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2926
Practice Address - Country:US
Practice Address - Phone:520-858-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health