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General NPI Number Information
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NPI Number | 1063110757
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Entity Type | Individual
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Provider Name | TILLARIE ELANA SISNEROS LPC ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 100 N MCGEE ST STE 42
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City | BORGER
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State | TX
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Zip | 79007-4016
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Country | US
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Telephone | 806-231-3764
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N MCGEE ST STE 42
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City | BORGER
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State | TX
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Zip | 79007-4016
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Country | US
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Telephone | 806-231-3764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 85180
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License Number State | TX
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