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General NPI Number Information
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NPI Number | 1326525510
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Entity Type | Organization
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Legal Business Name | SARAH TILLEY LMHC LLC
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 400 THOMAS DRIVE UNIT 7108
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32408
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Country | US
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Telephone | 515-373-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 3803 WHITEHEAD BLVD
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City | PANAMA CITY
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State | FL
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Zip | 32404-4102
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Country | US
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Telephone | 757-753-1939
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | SARAH TILLEY
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Credential | LMHC
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Telephone | 515-373-8391
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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 | 16517
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License Number State | FL
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