MEDICARE: AMANDA JOY TILLO LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	BBH-LCPC-LIC-82393	MT
2	101YP2500X	Professional Counselor	3071859	ID

General Provider Information

NPI Number	:	1447059886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOY TILLO LCPC

Provider Business Mailing Address
First Line	:	1017 JAYLEE DR UNIT 3
Second Line	:
City	:	RIGBY
State	:	ID
Zip	:	83442-4976
Country	:	US
Telephone Number	:	208-716-5288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1262 E 17TH ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6126
Country	:	US
Telephone Number	:	208-346-0688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2025
Last Update Date	:	04/08/2026

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Directions to “ AMANDA JOY TILLO LCPC” Practice Location

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