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General NPI Number Information
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NPI Number | 1336310689
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Entity Type | Individual
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Provider Name | DARRYL J. TILLER D. MIN.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 921 NE 13TH ST VAMC #125
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5007
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Country | US
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Telephone | 405-414-3205
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Fax |
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Provider Business Mailing Address
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Address Line | 921 NE 13TH ST VAMC #125
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5007
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Country | US
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Telephone | 405-414-3205
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 313
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License Number State | OK
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