MEDICARE: SANDRA LEE TILLMAN LPC

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	101YM0800X	Mental Health Counselor	9802	LA

General Provider Information

NPI Number	:	1619894821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LEE TILLMAN LPC

Provider Business Mailing Address
First Line	:	223 DOGWOOD ST
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70460-6925
Country	:	US
Telephone Number	:	985-773-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 FREMAUX AVE
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-3319
Country	:	US
Telephone Number	:	985-773-8880
Fax Number	:

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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