Healthcare Provider Details

I. General information

NPI: 1255795167
Provider Name (Legal Business Name): TAMMY HILLIARD M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 215
REDLANDS CA
92373-4724
US

IV. Provider business mailing address

101 E REDLANDS BLVD, SUITE 215
REDLANDS CA
92373
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1078
  • Fax:
Mailing address:
  • Phone: 909-793-1078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: