1326514118 NPI number — ALLAN RODNEY TILLEY LCDC

Table of content: ALLAN RODNEY TILLEY LCDC (NPI 1326514118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326514118 NPI number — ALLAN RODNEY TILLEY LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TILLEY
Provider First Name:
ALLAN
Provider Middle Name:
RODNEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCDC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326514118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NEW HOPE COUNSELING SERVICES
Provider Second Line Business Mailing Address:
1127 EAST MAIN, SUITE 100
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-257-3009
Provider Business Mailing Address Fax Number:
888-605-9651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 MAIN ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERRVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78028-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-257-3009
Provider Business Practice Location Address Fax Number:
888-605-9651
Provider Enumeration Date:
10/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  35799 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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