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NPI Code Detail

MEDICARE: TISSAN TILDEN JACKSON LCSW

MEDICARE: TISSAN TILDEN JACKSON LCSW
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
11041C0700XClinical Social WorkerC10433MS

General Provider Information

NPI Number : 1619103959
Entity Type Code : Individual
Provider Name (Legal Business Name) : TISSAN TILDEN JACKSON LCSW
Provider Business Mailing Address
First Line : 3450 HIGHWAY 80 W
Second Line :
City : JACKSON
State : MS
Zip : 39209-7201
Country : US
Telephone Number : 601-316-0951
Fax Number :
Provider Business Practice Location Address
First Line : 3450 HIGHWAY 80 W
Second Line :
City : JACKSON
State : MS
Zip : 39209-7201
Country : US
Telephone Number : 601-321-2400
Fax Number : 601-985-5174
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2009
Last Update Date : 09/04/2024

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Directions to “ TISSAN TILDEN JACKSON LCSW” Practice Location

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