Provider Demographics
NPI:1720687197
Name:TILLEY, DONNA (LPC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TILLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1033
Mailing Address - Country:US
Mailing Address - Phone:314-246-0560
Mailing Address - Fax:888-717-4730
Practice Address - Street 1:1170A E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2604
Practice Address - Country:US
Practice Address - Phone:636-312-6161
Practice Address - Fax:888-717-4730
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional