Provider Demographics
NPI:1982914263
Name:TILLMAN, SASAH IRENE (LMFT)
Entity Type:Individual
Prefix:
First Name:SASAH
Middle Name:IRENE
Last Name:TILLMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SASAH
Other - Middle Name:IRENE
Other - Last Name:TILLMAN RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4334 N HAZEL ST
Mailing Address - Street 2:APT 1308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1434
Mailing Address - Country:US
Mailing Address - Phone:815-557-6478
Mailing Address - Fax:
Practice Address - Street 1:4334 N HAZEL ST
Practice Address - Street 2:APT 1308
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1434
Practice Address - Country:US
Practice Address - Phone:815-557-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist