Healthcare Provider Details

I. General information

NPI: 1952004913
Provider Name (Legal Business Name): TILLIE MCGUIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 PINE ST
ABILENE TX
79601-3043
US

IV. Provider business mailing address

301 40TH ST
LUBBOCK TX
79404-2746
US

V. Phone/Fax

Practice location:
  • Phone: 325-696-0600
  • Fax: 325-676-3873
Mailing address:
  • Phone: 806-743-9355
  • Fax: 806-743-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number83938
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number83938
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number83938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: