Provider Demographics
NPI:1831843911
Name:TILLEY, MARCI JO (PLMHP)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:JO
Last Name:TILLEY
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3910
Mailing Address - Country:US
Mailing Address - Phone:712-204-1985
Mailing Address - Fax:
Practice Address - Street 1:AUGUSINE DR. #2
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health