Provider Demographics
NPI:1982295358
Name:TIER1 PERFORMANCE COACH
Entity Type:Organization
Organization Name:TIER1 PERFORMANCE COACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL PERFORMANCE COACH
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLINGHAST
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:302-357-0029
Mailing Address - Street 1:347 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-4013
Mailing Address - Country:US
Mailing Address - Phone:302-357-0029
Mailing Address - Fax:
Practice Address - Street 1:347 JESSICA DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-4013
Practice Address - Country:US
Practice Address - Phone:302-357-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Single Specialty