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General NPI Number Information
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NPI Number | 1215535117
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Entity Type | Individual
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Provider Name | ALEXIS NICOLE TILLERY LLMSW
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Gender | Female
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 30000 HIVELEY ST
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City | INKSTER
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State | MI
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Zip | 48141-1089
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Country | US
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Telephone | 173-472-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 30451 MARIMOOR ST
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5041
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Country | US
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Telephone | 248-804-1595
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801106976
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851106976
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851106976
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License Number State | MI
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