Healthcare Provider Details

I. General information

NPI: 1528992633
Provider Name (Legal Business Name): AARON JOSEPH TILLMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 CAPITAL CIR NE STE 304
TALLAHASSEE FL
32308-0596
US

IV. Provider business mailing address

1725 CAPITAL CIR NE STE 304
TALLAHASSEE FL
32308-0596
US

V. Phone/Fax

Practice location:
  • Phone: 850-980-5714
  • Fax:
Mailing address:
  • Phone: 850-989-5714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH25915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: