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NPI Code Detail

MEDICARE: JULIA TILLIE L.C.S.W.

MEDICARE: JULIA TILLIE L.C.S.W.
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
1104100000XSocial Worker42040TX
21041C0700XClinical Social Worker42040TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720028590
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA TILLIE L.C.S.W.
Provider Business Mailing Address
First Line : PO BOX 2603
Second Line :
City : FORT WORTH
State : TX
Zip : 76113-2603
Country : US
Telephone Number : 817-569-4913
Fax Number : 817-569-5098
Provider Business Practice Location Address
First Line : 3840 HULEN ST
Second Line : HTN, CLIENT ACCOUNTING
City : FORT WORTH
State : TX
Zip : 76107-7277
Country : US
Telephone Number : 817-569-4913
Fax Number : 817-569-5098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 01/31/2012

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